1. No category

Statistics on obesity,
physical activity and diet:
England, 2012
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
The NHS Information Centre
is England’s central, authoritative source
of health and social care information.
www.ic.nhs.uk
Author: The NHS Information Centre, Lifestyles Statistics.
Responsible Statistician: Paul Eastwood, Lifestyle Statistics Section Head
Version: 1
Date of Publication: 23 February 2012
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Contents
Executive Summary
6
1
Introduction
9
1.1 Obesity
9
2
3
4
1.2 Physical activity
10
1.3 Diet
11
1.4 Health Outcomes
12
References
14
Obesity among adults
15
2.1 Introduction
15
2.2 Overweight and obesity prevalence
16
2.3 Trends in obesity and overweight
17
2.4 Obesity and demographic characteristics
17
2.5 Obesity and lifestyle habits
17
2.6 Obesity and physical activity
18
2.7 Geographical patterns in obesity
18
2.8 The future
20
References
21
Obesity among children
23
3.1 Introduction
23
3.2 Trends in overweight and obesity
23
3.3 Relationship between obesity and income
24
3.4 Obesity and overweight prevalence by parental BMI
24
3.5 Obesity and Physical Activity
25
3.6 Regional, national and international comparisons
25
3.7 Attitudes to and knowledge of physical activity by BMI status
26
3.8 The future
27
References
28
Physical activity among adults
29
4.1 Background
29
4.2 Meeting physical activity guidelines
30
4.3 Physical fitness
31
4.4 Participation in different activities
32
4.5 Geographical patterns in physical activity
34
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
5
6
7
4.6 Sedentary time
35
4.7 Knowledge and attitudes towards physical activity
35
References
37
Physical activity among children
38
5.1 Introduction
38
5.2 Meeting physical activity guidelines
38
5.2.2 Objective measures of physical activity
39
5.3 Types of physical activity
40
5.4 Participation in Physical Education and school sport
41
5.5 Parental participation
42
5.6 Sedentary behaviour
42
5.7 Attitudes and perceptions to physical activity
43
References
44
Diet
45
6.1 Introduction
45
6.2 Adults’ diet
45
6.3 Children’s diet
48
References
51
Health outcomes
52
7.1 Introduction
52
7.2 Relative risks of diseases and death
52
7.3 Relationships between obesity prevalence and selected diseases
53
7.4 Hospital Episode Statistics
55
7.5 Prescribing
57
References
59
List of Tables
60
Appendix A: Key sources
76
Appendix B: Technical notes
90
Appendix C: Government policy, targets and outcome indicators
106
Appendix D: Further information
110
Appendix E: United Kingdom Statistics Authority Assessment of the
Statistics on Obesity, Physical Activity and Diet: England publication
116
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Executive Summary
This statistical report presents a range of information on obesity, physical activity and diet,
drawn together from a variety of sources. The topics covered include:
•
Overweight and obesity prevalence among adults and children;
•
Physical activity levels among adults and children;
•
Trends in purchases and consumption of food and drink and energy intake; and
•
Health outcomes of being overweight or obese.
This report contains seven chapters which consist of the following:
Chapter 1: Introduction; this summarises Government policies, targets and outcome indicators
in this area, as well as providing sources of further information and links to relevant
documents.
Chapters 2 to 6 cover obesity, physical activity and diet and provides an overview of the key
findings from these sources, whilst maintaining useful links to each section of these reports.
Chapter 7: Health Outcomes; presents a range of information about the health outcomes of
being obese or overweight which includes information on health risks, hospital admissions and
prescription drugs used for treatment of obesity. Figures presented in Chapter 7 have been
obtained from a number of sources and presented in a user-friendly format. Some of the data
contained in the chapter have been published previously by the NHS Information Centre (NHS
IC) or the National Audit Office. Previously unpublished figures on obesity-related Finished
Admission Episodes and Finished Consultant Episodes for 2010/11 are presented using data
from the NHS IC’s Hospital Episode Statistics as well as data from the Prescribing Unit at the
NHS IC on prescription items dispensed for treatment of obesity.
Main findings:
Obesity
In England:
•
Just over a quarter of adults (26% of both men and women aged 16 or over) were
classified as obese in 2010 (Body Mass Index (BMI) 30kg/m2 or over).
•
A greater proportion of men than women (42% compared with 32%) were classified as
overweight in 2010 (BMI 25 to less than 30kg/m2).
•
Women were more likely then men (46% and 34% respectively) to have a raised waist
circumference in 2010 (over 88cm for women and over 102 cm for men).
•
Using both BMI and waist circumference to assess risk of health problems, 22% of men
were estimated to be at increased risk; 12% at high risk and 23% at very high risk in 2010.
Equivalent figures for women were: 14%, 19% and 25%.
•
In 2010, around three in ten boys and girls (aged 2 to 15) were classed as either
overweight or obese (31% and 29% respectively), which is very similar to the 2009 findings
(31% for boys and 28% for girls).
6
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•
In 2010, 17% of boys and 15% of girls (aged 2 to 15) were classed as obese, an increase
from 11% and 12% respectively since 1995.
•
In 2010/11, the around one in ten pupils in Reception class (aged 4-5 years) were
classified as obese (9.4%) which compares to around a fifth of pupils in Year 6 (aged 10-11
years) (19.0%).
Physical Activity
In England (unless otherwise specified):
•
In 2010, 41% of respondents (aged 2+) said they made walks of 20 minutes or more at
least 3 times a week and an additional 23% said they did so at least once or twice a week
in Great Britain (GB). However, 20% of respondents reported that they took walks of at
least 20 minutes “less than once a year or never” in GB.
•
The most popular sports activity carried out by children aged 5 to10 in 2010/11 outside
school hours was swimming, diving or life saving with 48% participating in the previous four
weeks. This was followed by football (36%) and cycling or riding a bike (28%).
•
For children aged 11 to 15 the most popular sport activities participated in during the past
four weeks both in and out of school were football (50%), basketball (27%) and swimming,
diving or lifesaving (27%) in 2010/11.
•
Pupils in years 1 to 13 of the schools surveyed spent an average of 117 minutes in a
typical week in 2009/10 on curriculum PE. The long term trend shows an increase in the
average number of minutes pupils take part in PE each week.
Diet
In England (unless otherwise specified):
•
There has been a significant upward trend in household expenditure on eggs, butter,
beverages, sugar and preserves in the UK in 2010.
•
Household purchases of fruit fell by 0.9% in 2010 and are now 11.6% lower than 2007 in
the UK. Purchases of vegetables increased by 0.4% but are 2.9% lower than in 2007.
•
In 2010, 25% of men and 27% of women consumed the recommended five or more
portions of fruit and vegetables daily. These results are similar to those reported in 2009
and are slightly lower than in 2006 when 28% of men and 32% of women consumed at
least five potions daily.
•
Between 2009 and 2010, the percentage of 5-15 year old boys consuming 5 or more
portions of fruit and vegetables decreased from 21% to 19%. For 5-15 year old girls the
corresponding percentages showed a similar decrease from 22% to 20%.
•
Total energy intake per person fell 0.5% in 2010 in the UK. Total energy intake in 2010 was
2,292 kcal per person per day, in 2009 this was 2,303. Although the downward movement
since 2007 is not statistically significant there is a clear picture of a longer term downward
trend.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
7
Health Outcomes
In England:
•
In 2009, obese adults (aged 16 and over) were more likely to have high blood pressure
than those in the normal weight group. High blood pressure was recorded in 51% of men
and 46% of women in the obese group and in 20% of men and 15% of women in the
normal weight group.
•
The number of Finished Admission Episodes (FAEs) in NHS hospitals with a primary
diagnosis of obesity among people of all ages was 11,574 in 2010/11. This is over ten
times as high as the number in 2000/01 (1,054) and 1,003 more than in 2009/10 (10,571).
•
Over the period 2000/01 to 2010/11 in almost every year more than twice as many females
than males were admitted to hospital with a primary diagnosis of obesity. In 2010/11 almost
three times as many women as men were admitted with a primary diagnosis of obesity
(8,654 women compared to 2,919 men).
•
North East Strategic Health Authority (SHA) had the highest rate of admissions with a
primary diagnosis of obesity (40 admissions per 100,000 population) followed by the East
Midlands SHA (36 admissions per 100,000 population) and London (35 admissions per
100,000 population). South West, South Central and North West SHAs had the lowest
rates (14 admissions per 100,000 population).
•
The number of Finished Consultant Episodes (FCEs) for bariatric surgery rose to 8,087 in
2010/11 – 12 per cent higher than in 2009/10 when there were 7,214. In the last decade,
procedures saw a 30-fold increase from just 261 in 2000/01 to the current level – though
figures for more recent years also include procedures carried out to maintain an existing
gastric band rather than fit a new one. Of the 8,087 procedures for bariatric surgery carried
out in 2010/11, 1,444 were for maintenance of an existing band.
•
The East Midlands SHA had the highest rate of FCEs for bariatric surgery per 100,000 of
the population (32 procedures per 100,000 population). The North West SHA had the
lowest rate (6 procedures per 100,000 population) followed by East of England and South
Central SHAs (9 procedures per 100,000 population).
•
In 2010, there were 1.1 million prescription items dispensed for the treatment of obesity, a
24% decrease on the previous year when 1.4 million items were dispensed. This is the first
recorded decrease in seven years and could reflect the withdrawal from use of two of the
three drugs reported on which had been used to treat obesity (sibutramine in 2010 and
rimonabant in 2009).
8
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
1
Introduction
This annual statistical report presents a
range of information on obesity, physical
activity and diet, drawn together from a
variety of previously published sources. It
also presents new analyses not previously
published before which mainly consists of
data from The NHS Information Centre’s
Hospital Episode Statistics (HES)
databank as well as data from the
Prescribing Unit at The NHS Information
Centre. It also includes additional
analyses on the Health Survey for
England (HSE) dataset.
The HSE, one of the major sources of
information for this report, consists of a
series of annual surveys designed to
measure health and health-related
behaviours in adults and children living in
private households in England. The
survey was commissioned originally by
the Department of Health and, from April
2005 by The NHS Information Centre for
health and social care. The HSE has been
designed and carried out since 1994 by
the Joint Health Surveys Unit of the
National Centre for Social Research
(NatCen) and the Department of
Epidemiology and Public Health at the
University College London Medical School
(UCL). Wherever possible, the most
recent information available from the HSE
is presented. See Appendix A for further
detail on the HSE.
The data in this publication relate to
England unless otherwise specified.
Where figures for England are not
available, figures for Great Britain or the
United Kingdom have been provided.
Where relevant, links to the Scottish and
Welsh Health Survey data have been
provided.
measuring obesity is the Body Mass Index
(BMI). BMI is calculated by dividing a
person’s weight measurement (in
kilograms) by the square of their height (in
metres).
In adults, a BMI of 25 to 29.9kg/m2 means
that person is considered to be
overweight, and a BMI of 30kg/m2 or
above means that person is considered to
be obese.
In England, childhood obesity and being
overweight is defined using the UK 1990
growth reference (as used in the sources
of this report) or the UK/WHO growth
reference for children under 4 years of
age. This is because BMI varies with age
and sex in children and adolescents.
BMI is the best way we have to measure
the prevalence of obesity at the population
level. No specialised equipment is needed
and therefore it is easy to measure
accurately and consistently across large
populations. BMI is also widely used
around the world, not only in England,
which enables comparisons between
countries, regions and population subgroups. Height and weight data have been
collected in each year of the HSE series,
and waist circumference in most years.
Height and weight data have been used to
calculate (BMI); waist circumference has
been used to assess central obesity.
In 2006, the National Institute for Health
and Clinical Excellence (NICE) produced
guidelines on the prevention,
identification, assessment and
management of overweight and obesity in
adults and children.1 These guidelines
recommend a combination of BMI and
waist circumference to assess health risks
from obesity in adults.
1.1 Obesity
Overweight and obesity are terms that
refer to an excess of body fat and they
usually relate to increased weight-forheight. The most common method of
In November 2010, the new coalition
government set out its long-term vision for
the future of public health in England in
the White Paper, Healthy Lives, Healthy
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
9
People: Our Strategy for Public Health in
England.2 The White Paper describes a
new approach for public health in
England. It also sets out examples of
national level action to help tackle obesity.
This includes:
•
Continuing to run the National Child
Measurement Programme, including
sharing results with parents, so that
local areas have information about
levels of overweight and obesity in
children to inform planning and
commissioning of local services.
•
Helping consumers make healthier
food choices through the
Change4Life3 programme.
•
Working with business and other
partners through the Public Health
Responsibility Deal (see section on
Diet)
In October 2011, the Department of
Health published Healthy Lives, Healthy
People: a call to action on obesity in
England4 which sets out in more detail
how obesity will be tackled in the new
public health and NHS systems.
The Public Health Outcomes Framework5
was published in January 2012. The
document sets out the desired outcomes
for public health and how these will be
measured. The framework includes
specific indicators for excess weight in
adults and excess weight in 4-5 and 10-11
year olds (as well as indicators for the
proportion of physically active and inactive
adults and an indicator for diet).
Chapter 2 on Obesity among adults in this
report presents the obesity prevalence
rates and trends among adults. The
relationship between obesity and various
factors such as sex, demographics and
lifestyle habits are also explored. Chapter
3 on Obesity among children focuses on
obesity prevalence rates and trends for
children, and again, explores the
relationship between obesity and various
factors.
1.2 Physical activity
In 2011, the UK Chief Medical Officers
(CMOs) published revised guidelines for
physical activity. For the first time the
guidelines take a lifecourse approach,
updating the guidelines for adults, children
and young people and including
guidelines for early years and older
people. The UK CMOs recommend that
adults should achieve at least 150 minutes
of at least moderate intensity physical
activity a week, it recognises the
comparable benefits of achieving 75
minutes of vigorous intensity activity. The
CMOs also recommend that children and
young people should achieve a total of at
least 60 minutes of at least moderate
intensity physical activity each day. Start
Active, Stay Active6 includes the
guidelines for early years, encouraging
physical activity from birth and for at least
180 minutes a day for those who are able
to walk. It also includes guidelines on
reducing sedentary behaviour for all age
groups. Start Active, Stay Active
supersedes the CMO’s previous report (in
2004) on At least 5 a week: Evidence on
the impact of physical activity and its
relationship to health.7
In 2007, a Public Service Agreement
(PSA) 22 indicator8 was introduced by the
then government to deliver a successful
Olympic and Paralympic Games and to
get more children and young people
taking part in high quality PE and sport.
The PE and Sports Strategy for Young
People supported the delivery of PSA22
which have now been superseded. In
December 2010, the Secretary of State for
Culture, Media and Sport published the
coalition Government’s high-level vision
for achieving a lasting legacy from the
Olympic Games: Plans for the Legacy
from the 2012 Olympic and Paralympic
Games.9 One of the key themes is to:
harness the UK’s passion for sport to
increase grass roots participation,
particularly by young people – and to
encourage the whole population to be
more physically active.
10 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
In order to tackle physical inactivity
outside school, initiatives such as the
Change4Life continue to be driven forward
(in conjunction with tackling obesity and
healthier eating). Change4Life has now
expanded to focus on adults, with the Get
Going Everyday10 campaign to encourage
adults to increase their physical activity
levels.
other non-dairy sources of protein. Foods
and drinks high in salt, fat and sugar
should be consumed infrequently and in
small amounts. This is visually
represented in the eatwell plate,13 a policy
tool that helps to make healthier eating
easier to understand, showing the types
and proportions of foods needed for a
healthy, balanced diet.
The Government is also seeking to
increase participation in sport and physical
activity by working with business, the third
sector and others through the Public
Health Responsibility Deal11, launched on
15 March 2011. The Physical Activity
Network is one of five networks created
through the Deal.
One of the aims of the Public Health
Responsibility Deal is to tap into the
potential for businesses and other
organisations to improve public health and
tackle health inequalities through their
influence over food, alcohol, physical
activity and health in the workplace. It will
help deliver voluntary agreements or
‘pledges’ to improve public health through
activities such as further reformulation of
food; better information for consumers
about food; and promotion of more
socially responsible retailing and
consumption of alcohol.
Chapter 4 on Physical activity among
adults and Chapter 5 on Physical activity
among children cover information on self
reported activity and accelerometry.
Physical activity levels, according to
physical activity guidelines, and types of
physical activity are considered. These
chapters also cover information on adults’
and children’s knowledge and attitudes
towards exercise and physical activity.
Other than the HSE, other sources of
information on physical activity include the
latest Taking Part Survey, The National
Travel Survey, The Active People Survey,
The PE and Sport Survey and other
fitness surveys.
The Active People Survey, published by
Sport England, provides information on
participation in sport and recreation. It
provides the data for the local area
estimates of adult participation in sport
and active recreation (formerly National
Indicator 8).
1.3 Diet
Current government recommendations are
that everyone should eat plenty of fruit
and vegetables (at least 5 of a variety
each day),12 plenty of potatoes, bread, rice
and other starchy foods, some milk and
dairy foods, meat, fish, eggs, beans and
Taking forward the Department for
Environment, Food and Rural Affairs’
(Defra) Fruit and Vegetables Task Force
recommendation on fruit and vegetables,
the Department of Health (DH) convened
an external reference group to provide
advice on possible approaches to extend
the 5 A DAY logo scheme to include
composite foods (i.e. those foods with
more than one ingredient, one of which is
a fruit or vegetable). The advice from this
external reference group was provided to
DH in May 2011 and options arising from
this advice are being considered by DH in
consultation with the food industry and
Civil Society organisations.
Chapter 6 on Diet covers purchases and
consumption of food and drink and related
intake of energy and nutrients. Also
covered are adults’ and children’s
consumption and knowledge of the
recommended number of portions of fruit
and vegetables a day plus attitudes
towards a healthy diet.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
11
Other than the HSE, other sources of
information on diet include the latest
Living Cost and Food Survey and the
National Diet and Nutrition Survey.
1.4 Health Outcomes
Chapter 7 on Health Outcomes focuses
on outcomes related to being overweight
or obese, in particular blood pressure. The
risks of diseases linked to obesity are
discussed in this chapter, as well as
information on hospital episodes with a
primary or secondary diagnosis of obesity,
‘bariatric surgery’ and prescriptions for the
treatment of obesity.
Throughout the report, references are
given to sources for further information
which are provided at the end of each
chapter.
The report also contains five appendices:
Appendix A describes the key sources
used in more detail; Appendix B provides
further details on measurements,
classifications and definitions used in the
various sources; Appendix C covers
government policy, targets and outcome
indicators related to obesity, physical
activity or diet; Appendix D lists sources of
further information and useful contacts
and Appendix E details the requirements
and suggestions made by the United
Kingdom Statistics Authority (UKSA)
during their assessment of this
publication.
1.5 United Kingdom Statistics
Authority assessment
This statistical release is a National
Statistics publication. National Statistics
are produced to high professional
standards set out in the Code of Practice
for Official Statistics. It is a statutory
requirement that National Statistics should
observe the Code of Practice for Official
Statistics. The United Kingdom Statistics
Authority (UKSA) assesses all National
Statistics for compliance with the Code of
Practice.
Most of the sources referred to in this
publication are National Statistics.
National Statistics are produced to high
professional standards set out in the Code
of Practice for Official Statistics. It is a
statutory requirement that National
Statistics should observe the Code of
Practice for Official Statistics. UKSA
assesses all National Statistics for
compliance with the Code of Practice.
Some of the statistics referred to in this
publication are not National Statistics and
are included here to provide a fuller
picture; some of these are Official
Statistics, whilst others are neither
National Statistics nor Official Statistics.
Those which are Official Statistics should
still conform to the Code of Practice for
Official Statistics, although this is not a
statutory requirement. Those that are
neither National Statistics nor Official
Statistics may not conform to the Code of
Practice for Official Statistics.
During 2010, the Statistics on Obesity,
Physical Activity and Diet: England
publications underwent assessment by the
UKSA. In accordance with the Statistics
and Registration Service Act 2007 and
signifying compliance with the Code of
Practice for Official Statistics these
statistics were recommended continued
designation as National Statistics.
Designation can be broadly interpreted to
mean that the statistics:
•
meet identified user needs;
•
are well explained and readily
accessible;
•
are produced according to sound
methods; and
•
are managed impartially and
objectively in the public interest.
Once statistics have been designated as
National Statistics it is a statutory
requirement that the Code of Practice
shall continue to be observed.
12 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
The designation of National Statistics
status was subject to a number of
requirements. The UKSA report also
contained a number of suggestions for
improvement. Further details on these
requirements and suggestions, including
detail on how these are being addressed
are contained in Appendix E.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
13
References
1. Obesity: the prevention, identification,
assessment and management of
overweight and obesity in adults and
children. National Institute for Health
and Clinical Excellence, 2006.
Available at:
http://www.nice.org.uk/guidance/CG43
2. Health Lives, Healthy People: Our
Strategy for Public Health in England.
Department of Health, 2010. Available
at:
http://www.dh.gov.uk/en/Publicationsa
ndstatistics/Publications/PublicationsP
olicyAndGuidance/DH_121941
3. Change4Life. Department of Health,
2009. Available at:
http://www.dh.gov.uk/en/News/Current
campaigns/Change4life/index.htm
4. Health Lives, Healthy People: A Call to
Action on Obesity in England.
Department of Health, 2011. Available
at:
http://www.dh.gov.uk/en/Publicationsa
ndstatistics/Publications/PublicationsP
olicyAndGuidance/DH_130401
5. Healthy lives, healthy people:
Improving outcomes and supporting
transparency - A Public Health
Outcomes Framework. Department for
Health, 2012. Available at:
http://www.dh.gov.uk/en/Publicationsa
ndstatistics/Publications/PublicationsP
olicyAndGuidance/DH_132358
Department of Health. Available at:
www.dh.gov.uk/en/Publicationsandstat
istics/Publications/PublicationsPolicyA
ndGuidance/DH_4080994
8. CSR 2007 public service agreements.
HM-Treasury. Available at:
http://www.hmtreasury.gov.uk/d/pbr_csr07_psa22.pd
f
9. Plans for the Legacy from the 2012
Olympic and Paralympic Games.
Department for Culture, Media and
Sport, 2010. Available at:
http://www.culture.gov.uk/publications/
7674.aspx
10. Get Going Everyday. Available at:
http://www.nhs.uk/Change4Life/Pages/
daily-activity-tips.aspx
11. Public Health Responsibility Deal.
Department of Health, 2011. Available
at:
http://www.dh.gov.uk/en/Publichealth/
Publichealthresponsibilitydeal/index.ht
m
12. 5-a-day. Department of Health, 2003.
Available at:
http://www.dh.gov.uk/en/Policyandguid
ance/Healthandsocialcaretopics/FiveA
Day/index.htm
13. The Eatwell Plate. Department of
Health, 2011. Available at:
http://www.dh.gov.uk/en/Publichealth/
Nutrition/DH_126493
6. Start Active, Stay Active: A report on
physical activity for health from the
four home countries Chief Medical
Officers, 2011. Available at:
http://www.dh.gov.uk/en/Publicationsa
ndstatistics/Publications/PublicationsP
olicyAndGuidance/DH_128209
7. At least 5 a week: Evidence on the
impact of physical activity and its
relationship to health – A report from
the Chief Medical Officer, 2004. The
14 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
2
Obesity among adults
2.1 Introduction
The main source of data on the prevalence of
overweight and obesity is the Health Survey
for England (HSE). The HSE is an annual
survey designed to monitor the health of the
population of England. The report is written by
NatCen Social Research (previously National
Centre for Social Research) and published by
the NHS Information Centre (NHS IC). Most of
the information presented in this chapter is
taken from the recently published HSE 2010.1
This chapter focuses on the prevalence of
overweight and obesity in adults, presented by
Body Mass Index (BMI) and also by waist
circumference. Trends in the prevalence of
being overweight or being obese are
presented and relationships between various
economic and lifestyle variables and obesity
are discussed. Regional, national and
international comparisons have been provided
as well as the Quality and Outcomes
Framework (QOF) obesity prevalence rates.
Participation by practices in the QOF is
voluntary, though participation rates are very
high.
The chapter also includes a focus on future
predictions of adult obesity, which refers to
other research reports.
2.1.1 Measurement of overweight and
obesity
The calculation of BMI is a widely accepted
method used to define overweight and obesity.
Guidance published by the National Institute
for Health and Clinical Excellence (NICE)2
postulates that within the management of
overweight and obesity in adults, BMI should
be used to classify the degree of obesity and
to determine the health risks. However, this
needs to be interpreted with caution as BMI is
not a direct measure of obesity. NICE
recommends the use of BMI in conjunction
with waist circumference as the method of
measuring overweight and obesity and
determining health risks, specifically, the
guidance currently states that assessment of
health risks associated with overweight and
obesity should be based on both BMI and
waist circumference for those with a BMI of
less than 35 kg/m2. Hence this chapter
focuses on using BMI and using BMI with
waist circumference in order to define
overweight and obesity in adults.
2.1.2 Measurement of BMI
BMI is defined as weight in kilograms divided
by the square of the height in metres (kg/m2).
Figure 2.1 presents the various BMI ranges
used to define BMI status.
Figure 2.1 BMI definitions
Definition
2
BMI range (kg/m )
Underweight
Normal
Under 18.5
18.5 to less than 25
Overweight
25 to less than 30
Obese
30 to less than 40
Obese I
30 to less than 35
Obese II
35 to less than 40
Morbidly obese
40 and over
Overweight including obese
25 and over
Obese including morbidly obese
30 and over
Where the prevalence of obesity is referred to
in this chapter it is referring to those who are
obese or morbidly obese (i.e. with a BMI of
30kg/m2 or over) unless otherwise stated.
2.1.3 Waist circumference
Although BMI allows for differences in height,
it does not distinguish between mass due to
body fat and mass due to muscular physique,
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
15
or for the distribution of fat. Therefore, waist
circumference is also a widely recognised
measure used to identify those with a health
risk from being overweight. A raised waist
circumference is defined as greater than
102cm in men and greater than 88cm in
women.
2.1.4 NICE risk categories
NICE guidelines on prevention, identification,
assessment and management of overweight
and obesity highlight their impact on risk
factors for developing long-term health
problems. It states that the risk of these health
problems should be identified using both BMI
and waist circumference for those with a BMI
less than 35kg/m2. For adults with a BMI of
35kg/m2 or more, risks are assumed to be very
high with any waist circumference (see Figure
2.2).
Figure 2.2: NICE risk categories
comparison 31% of men and 40% of women
had a BMI in the normal range.
Overall, mean BMI in men was 27.4kg/m2 and
in women was 27.1kg/m2 and as with the
prevalence of overweight including obesity,
was higher in older age groups. Prevalence of
overweight including obese varied by age,
being lowest in the 16–24 age group, and
higher in the older age groups among both
men and women. Figure 10A on page 6 of
Chapter 10 the HSE 2010 report shows
prevalence of overweight and obesity by age
and gender for 2010.
2.2.2 Waist circumference
Table 10.6 on page 19 of Chapter 10 of the
HSE 2010 report shows the distribution of
mean waist circumference and prevalence of
raised waist circumference by age and gender
for 2010.
In 2010, 40% of adults had a raised waist
circumference. Women were significantly more
likely than men to have a raised waist
circumference (46% and 34% respectively).
Again both mean waist circumference and the
prevalence of a raised waist circumference
were generally higher in older age groups.
2.2.3 Health risk associated with BMI
and waist circumference
2.2 Overweight and obesity
prevalence
2.2.1 BMI
Chapter 10 of the HSE 2010 report provides
information on anthropometric measures
(height, weight, waist and hip circumference),
overweight and obesity. In particular, Table
10.2 on page 14 shows BMI prevalence
among adults by age and gender for 2010.
The key findings show that in 2010, just over a
quarter of adults (26% of both men and
women) were obese, and 42% of men and
32% of women were overweight. In
Table 10.10 on pages 22 and 23 of Chapter 10
of the HSE 2010 shows the increased health
risks associated with high and very high waist
circumference, when combined with BMI to
classify the risks (see Figure 2.2 for definition
of high and very high waist circumference).
Using combined categories of BMI and waist
circumference to assess overall health risk:
22% of men were at increased risk, 12% at
high risk and 23% at very high risk. The
equivalent proportions for women were: 14%,
19% and 25%.
16 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
2.3 Trends in obesity and
overweight
2.3.1 BMI
Table 4 from the HSE 2010 Adult Trend
Tables3 shows that in England the proportion
of adults with a normal BMI decreased
between 1993 and 2010, from 41.0% to 30.9%
among men and from 49.5% to 40.4% among
women. For both men and women, the
proportions that were overweight were stable
over the same period (approximately 40% for
men and 30% for women). There was however
a marked increase in the proportion that were
obese, a proportion that has gradually
increased over the period from 13.2% in 1993
to 26.2% in 2010 for men and from 16.4% to
26.1% for women. This increase is also shown
in Figure 10E on page 10 of Chapter 10 of the
HSE 2010 report (based on a 3 year moving
average).
2.3.2 Waist circumference
Table 5 from the HSE 2010 Adult Trend
Tables shows that between 1993 and 2010,
the proportion of adults with a raised waist
circumference also increased, from 23% to
40% (from 20% to 34% among men and from
26% to 46% among women).
2.4 Obesity and demographic
characteristics
The HSE 2010 uses equivalised household
income (a measure of household income that
takes account of the number of people in the
household – see Appendix B of this report for
more details) to help identify patterns in
obesity and raised waist circumference.
Table 10.4 on page 17 of Chapter 10 of the
HSE 2010 report shows that there were very
little differences in mean BMI by equivalised
household income for men; in contrast for
women, those in the lower income quintiles
had a higher mean BMI than women in the
higher quintiles. For women, the proportions
who were obese were higher in the lowest
income quintiles and lower in the highest
quintiles (ranging from 17%-34%). The
relationship between BMI and income for men
was less clear.
Table 10.8 on page 21 of Chapter 10 of the
HSE 2010 report shows that the proportion of
women with a raised waist circumference was
also lowest in the highest income quintile
(36%) and highest in the lowest income
quintile (53%). As with BMI, there was no clear
relationship between waist circumference and
equivalised household income for men.
2.5 Obesity and lifestyle
habits
Previous years’ HSE reports have included
more detailed exploration of the lifestyle
factors associated with obesity measures. The
HSE 2007 report4 included a regression
analysis of the risk factors for those classified
as ‘most at risk’ according to the NICE
categories using BMI and waist circumference
criteria; the HSE 2006 report5 included a
regression analysis exploring the risk factors
associated with a raised waist circumference;
and the HSE 2003 report6 included a
regression analysis of risk factors associated
with overweight and obesity.
The HSE 2007 report used logistic regression
(see Section 3.3.7 on pages 44 to 46 of HSE
2007 and Appendix B of this report for more
details) to identify the risk factors associated
with being in the ‘most at risk’ categories (high
or very high risk). For both men and women,
being ‘most at risk’ was positively associated
with: age; being an ex-cigarette smoker; self
perceptions of not eating healthily; not being
physically active; and hypertension. Income
was also associated with being ‘most at risk’,
with a positive association for men and a
negative association for women. Additionally,
among women only, moderate alcohol
consumption was negatively associated with
being ‘most at risk.’
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
17
2.6 Obesity and physical
activity
Self-reported physical activity levels were last
included in the HSE 20087 report. Figure 2C
and Table 2.5 on pages 31 and 47 of the HSE
2008 show self reported activity levels by BMI
category. Both men and women who were
overweight (BMI 25 to less than 30 kg/m2) or
obese (BMI 30 kg/m2 or more) were less likely
to meet the recommendations compared with
men and women who were not overweight or
obese (BMI less than 25 kg/m2). Forty-six per
cent of men who were not overweight or obese
met the recommendations, compared with
41% of overweight men and 32% of obese
men. A similar pattern emerged for women,
with 36% of women who were not overweight
or obese meeting recommendations,
compared with 31% of overweight and 19% of
obese women. Given these findings, it is not
surprising that obese men and women had the
highest rates of low activity (36% and 46%
respectively).
Table 3.6 on page 84 of the HSE 2008 report
shows the average number of minutes per day
in sedentary time and all moderate to vigorous
physical activity (MVPA) by BMI category
based on accelerometry data (an objective
measure of physical activity), and Figure 3C
on page 69 shows the data for MVPA time.
Those who were not overweight or obese
spent fewer minutes on average in sedentary
time (591 minutes for men, 577 minutes for
women) than those who were obese (612
minutes for men, 585 minutes for women).
Similarly, those not overweight or obese spent
more MVPA minutes than those who were
overweight or obese.
Further information on adult physical activity
linked to obesity can be found in Chapter 4 of
this report.
2.7 Geographical patterns in
obesity
2.7.1 Obesity and waist circumference
by Strategic Health Authority
Table 10.3 on page 15 of Chapter 10 of the
HSE 2010 report shows that among the
different Strategic Health Authorities (SHAs) in
England, no significant statistical differences
were observed in men or women in mean BMI
or prevalence of overweight and obesity.
Table 10.7 on page 20 of Chapter 10 of the
HSE 2010 report also shows there was no
significant variation in the distribution of mean
waist circumference or raised waist
circumference by SHA.
2.7.2 Quality and Outcomes Framework
The QOF for 2010/118 includes an indicator
which rewards GP practices for maintaining an
obesity register of patients (aged 16 and over)
with a BMI greater than or equal to 30,
recorded in the previous 15 months. The
recording of BMI for the register takes place in
the practice as part of routine care. The
underlying data includes the number of
patients on the obesity register and the
number of obese patients registered as a
proportion of the practice list size. See
Appendix A for more information on QOF.
In England in 2010/11, it was calculated that
the prevalence rate based on GP obesity
registers was 10.5%; much lower than the
26.1% for adults reported in HSE 2010. This
could be due to a number of reasons. Not all
patients will be measured and there may be
some obese people who have not recently
visited their GP. While perhaps not able to
demonstrate the complete extent of obesity
prevalence, QOF can be a useful indicator of
the number of people whose health is being
monitored due to their obesity. To be included
in the QOF obesity register a patient must be
aged 16 or over and have a record of a BMI of
30 or higher in the previous 15 months. This
requirement results in the prevalence of
obesity in QOF being much lower than the
18 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
prevalence found in the Health Survey for
England and other surveys.
on pages 66 to 67 of the Welsh Health Survey
2010.12
The Quality and Outcomes Framework (QOF)
prevalence data tables for 2010/119 show a
breakdown of obesity at a regional level.
Prevalence rates based on the QOF ranged
from 13.1% in North East SHA to 9.0% in
South East Coast SHA in 2010/11. Figure 2.3
shows the obesity prevalence rates from QOF
for each SHA in England in 2010/11. There is
clearly a north-south divide with northern
England having higher obesity prevalence
rates than southern England.
In Scotland, 28% of adults were classified as
obese, and 65% of adults were classified as
being overweight or obese. In Wales, 22% of
adults were classified as obese, and 57% of
adults were classified as being overweight or
obese. This compares with 26% of adults
being obese in England and 63% of adults
being overweight or obese.
Figure 2.3 Obesity prevalence rates
quoted by QOF for each SHA in 2010/11
SHA
North East
North West
Yorkshire and The Humber
East Midlands
West Midlands
East of England
London
South East Coast
South Central
South West
Obesity prevalence
(%)
13.1%
11.5%
11.3%
10.9%
11.8%
10.3%
9.3%
9.0%
9.2%
9.9%
2.7.3 National and international
comparisons
Scotland and Wales carry out their own health
surveys. Adult BMI information can be found in
Section 7.5 on pages 164 and 165 and Tables
7.1 and 7.3 on pages 173 to177 of the Scottish
Health Survey 2010.10 The Scottish
Government also published an Obesity Topic
Report11 alongside the Scottish Health Survey
2010 which investigates into the most
appropriate measure of adult obesity using
Scottish Health Survey data, and also
investigates into the significant behavioural,
socio-demographic and economic factors
associated with adult obesity using data from
the 2008, 2009 and 2010 surveys.
Adult BMI information for Wales can be found
in Section 4.7 on pages 63 to 34 and Table 4.1
Details of the methodologies used by each
country are contained within the publications.
These will need to be considered when
attempting comparisons.
The Organisation for Economic Co-operation
and Development (OECD) in 2011 published
Health at a Glance 201113 which includes data
on overweight and obese populations across
different countries. Based on latest available
health surveys, more than half (50.3%) of the
adult population in the OECD reported that
they were overweight or obese. The least
obese countries were India (2.1%), Indonesia
(2.4%) and China (2.9%) and the most obese
countries were the US (33.8%), Mexico
(30.0%) and New Zealand (26.5%).
Among those countries where height and
weight were measured, the overweight or
obese proportion was even greater at 55.8%.
The prevalence of overweight and obesity
among adults exceeds 50% in no less than 19
of 34 OECD countries.
Obesity prevalence has more than doubled
over the past 20 years in Australia and New
Zealand, and increased by half in the United
Kingdom and the United States. Some 20-24%
of adults in Australia, Canada, the United
Kingdom and Ireland are obese, about the
same rate as in the United States in the early
1990s. Obesity rates in many western
European countries have also increased
substantially over the past decade. The rapid
rise occurred regardless of where levels stood
two decades ago. Obesity almost doubled in
both the Netherlands and the United Kingdom,
even though the current rate in the
Netherlands is around half that of the United
Kingdom.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
19
Figure 2.3.1 of the OECD report shows the
prevalence of obesity among adults (2009
data) across the OECD countries and Figure
2.3.2 shows the increasing obesity rates
among the adult population in OECD
countries, 1990, 2000 and 2009 (or nearest
years).
2.8 The future
There are various research reports and journal
articles available that use HSE data to predict
future obesity trends in adults. The report by
Foresight at The Government Office for
Science produced the Tackling Obesities:
Future Choices report14 which provides a
long-term vision of how we can deliver a
sustainable response to obesity in the UK over
the next 40 years. HSE data from 1994 to
2004 were used as a basis of modelling
obesity prevalence up to 2050.
By 2015, the Foresight report estimates that
36% of males and 28% of females (aged
between 21 and 60) will be obese. By 2025 it
is estimated that 47% of men and 36% of
women will be obese.
Another research report published in 2008 by
the British Medical Journal Group, Trends in
obesity among adults in England from 1993 to
2004 by age and social class and projections
of prevalence to 201215 predicted that the
prevalence of obesity will increase to 32.1% in
men and 31.0% in women by 2012 based on
1993-2004 obesity prevalence trend data. The
HSE 2010 data shows that the current rate is
26% for both men and women. In a couple of
years we will be able to compare against these
modeled estimates.
The predicted 2012 obesity prevalence for
adults in manual social classes is higher (34%)
than adults in non-manual social classes
(29%). The report also concludes that if recent
trends in adult obesity continue, about a third
of all adults in England (almost 13 million
adults) would be obese by 2012, of which
around 34% will be from the manual social
class – in a couple of years these estimates
can also be compared against actual data.
20 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
References
1. Health Survey for England – 2010:
Respiratory Health. The NHS
Information Centre, 2011. Available at:
www.ic.nhs.uk/pubs/hse10report
2. Obesity: the prevention, identification,
assessment and management of
overweight and obesity in adults and
children. National Institute for Health
and Clinical Excellence (NICE), 2006.
Available at:
www.nice.org.uk/guidance/CG43
3. Health Survey for England – 2010:
Trend Tables. The NHS Information
Centre, 2011. Available at:
www.ic.nhs.uk/pubs/hse10trends
4. Health Survey for England 2007. The
NHS Information Centre, 2008.
Available at:
http://www.ic.nhs.uk/pubs/hse07healthy
lifestyles
5. Health Survey for England 2006. The
NHS Information Centre, 2007.
Available at:
http://www.ic.nhs.uk/pubs/hse06cvdand
riskfactors
6. Health Survey for England 2003.
Department of Health, 2004. Available
at:
www.dh.gov.uk/assetRoot/04/09/89/11/
04098911.pdf
7. Health Survey for England 2008. The
NHS Information Centre, 2009.
Available at:
http://www.ic.nhs.uk/pubs/hse08physic
alactivity
8. Quality and Outcomes Framework
2010/11. The NHS Information Centre,
2011. Available at:
http://www.ic.nhs.uk/statistics-and-datacollections/supportinginformation/audits-andperformance/the-quality-and-outcomesframework/qof-2010-11/qof-2010-11bulletin
9. Quality and Outcomes Framework
Prevalence data tables 2010/11. The
NHS Information Centre, 2011.
Available at:
http://www.ic.nhs.uk/statistics-and-datacollections/supportinginformation/audits-andperformance/the-quality-and-outcomesframework/qof-2010-11/qof-2010-11data-tables/qof-prevalence-data-tables2010-11
10. The Scottish Health Survey 2010,
Volume 1: Main Report. Scottish
Government, 2011. Available at:
http://www.scotland.gov.uk/Publications
/2011/09/27084018/0
11. The Scottish Health Survey: Topic
Report: Obesity. Scottish Government,
2011. Available at:
http://www.scotland.gov.uk/Resource/D
oc/361003/0122058.pdf
12. The Welsh Health Survey, 2010. Welsh
Assembly, 2011. Available at:
http://wales.gov.uk/docs/statistics/2011/
110913healthsurvey10en.pdf
13. Health at a Glance 2011. Organisation
for Economic Co-operation and
Development, 2011. Available at:
http://www.oecd.org/dataoecd/6/28/491
05858.pdf
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
21
14. Tackling Obesities: Future Choices 2nd
Edition – Modelling Future Trends in
Obesity and Their Impact on Health.
Foresight, Government Office for
Science, 2007. Available at:
http://www.bis.gov.uk/assets/bispartner
s/foresight/docs/obesity/17.pdf
15. Zaninotto, P. et al. (2009) Trends in
obesity among adults in England from
1993 to 2004 by age and social class
and projections of prevalence to 2012.
Journal of Epidemiology and
Community Health, 63:140-146.
Available at:
http://jech.bmj.com/content/early/2008/
12/11/jech.2008.077305.abstra
22 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
3
Obesity among children
3.1 Introduction
This chapter presents key information about
the prevalence of overweight and obesity in
children aged 2 to 15 living in England, using
data from the Health Survey for England
(HSE) 2010.1 As described in Chapter 1, the
HSE is an annual survey and has provided
information about the health of children since
1995. Information is presented showing
relationships between obesity prevalence and
income, parental Body Mass Index (BMI) and
children’s physical activity levels, and also
provides regional comparisons. Information on
children’s attitudes to physical activity and
obesity are also included.
This chapter also presents recent 2010/11
data from the National Child Measurement
Programme for England (NCMP)2 which
provides the most comprehensive data on
obesity and being overweight among children,
generally aged 4-5 and 10-11 years, based on
Reception class and school year 6. The
findings are used to inform local planning and
delivery of services for children and gather
population-level surveillance data to allow
analysis of trends in weight.
The final part of this chapter focuses on future
predictions of childhood obesity, which refers
to other research reports.
3.1.1 Measurement of overweight and
obesity among children
As with adults, the HSE collects height and
weight measurements to calculate BMI for
each child. BMI (adjusted for age and gender)
is recommended as a practical estimate of
overweight and obesity in children. The
measurement of obesity and overweight
among children needs to take account of the
different growth patterns among boys and girls
at each age, therefore a universal
categorisation cannot be used to define
childhood obesity as is the case with adults.
Each sex and age group needs its own level of
classification for overweight and obesity. The
data presented in this chapter uses the British
1990 growth reference (UK90) to describe
childhood overweight and obesity. This uses a
BMI threshold for each age above which a
child is considered overweight or obese. The
classification estimates were produced by
calculating the percentage of boys and girls
who were over the 85th (overweight) or 95th
(obese) BMI percentiles based on the 1990
UK reference population.
3.2 Trends in overweight and
obesity
Table 11.2 on page 15, Chapter 11 of the HSE
2010 report shows that around three in ten
boys and girls aged 2 to 15 were classed as
either overweight or obese (31% and 29%
respectively), which is very similar to the HSE
2009 findings (31% for boys and 28% for
girls).
Mean BMI was similar overall among girls and
boys aged 2-15 (a difference of 0.1kg/m2).
While mean BMI was generally similar among
younger children of both sexes, the mean was
higher among older girls than boys, with a gap
ranging from 0.4kg/m2 to 1.1kg/m2 among
those aged 12-15.
Table 4 of the HSE 2010 Child Trend Tables3
shows that among boys aged 2 to 15, the
proportion who were obese increased overall
between 1995 and 2004 where the prevalence
increased from 11.1% to 19.4%, but has
steadily fallen between then and 2010 to
17.1%. Among girls in the same age group,
the proportion who were obese increased from
12.2% to 18.8% between the years of 1995
and 2005 but since then has steadily
decreased to 14.8% in 2010. Whilst there have
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
23
been marked increases in the prevalence of
obesity since 1995, the prevalence of
overweight children aged 2 to 15 has
remained largely unchanged and in 2010 this
was 14.3% for boys and 14.4% for girls. (Note:
data for 1995 to 2007 in Table 4 were revised
in November 2009).
The same overall obesity increase was
apparent among both younger children aged 2
to 10 and children aged 11 to 15. For boys
aged 2 to 10, the prevalence of obesity
increased overall from 9.7% in 1995, peaking
at 17.4% in 2006 but then steadily falling to
15.3% in 2010. Among girls the prevalence of
obesity increased from 10.6% in 1995 to
17.4% in 2005 but had similarly decreased by
2010 to 13.9%. In the 11 to 15 age group,
obesity increased among boys from 13.9% in
1995 to 24.3 in 2004, falling back to 19.9% in
2010. The situation is similar among girls,
increasing from 15.5 in 1995 to 26.7% in 2004
but decreasing to 16.6% in 2010.
Figure 11D on page 9 of Chapter 11 of the
HSE 2010 report shows the obesity trend as a
3 year moving average. This suggests that the
trend in obesity now appears to be flattening
out, and future HSE data will be important in
confirming whether this is a continuing pattern,
or whether this is a plateau within the longer
term trend which is still gradually increasing.
In 2010/11, the NCMP data shows that around
one in ten pupils in Reception class (aged 4-5
years) were classified as obese (9.4%) which
compares to around a fifth of pupils in Year 6
(aged 10-11 years) (19.0%). Also, 13.2% of
pupils in Reception class and 14.4% of pupils
in Year 6 were reported as being overweight.
Obesity prevalence was significantly higher in
urban areas than in rural areas for both school
years, as was the case in previous years.
The obesity prevalence among Reception year
children living in urban areas was 9.7%
compared with 8.1% and 7.8% living in town
and village areas respectively. Similarly,
obesity prevalence among Year 6 children
living in urban areas was 19.6% compared
with 16.7% and 15.9% living in town and
village areas respectively.
Section 13.5 on page 318 of the HSE 2008
report includes a comparison of NCMP and
HSE data, outlining the differences between
results and methods of collection.
3.3 Relationship between
obesity and income
Figure 11B on page 6 of Chapter 11 of the
HSE 2010 report shows the proportion of
children who were overweight or obese in
each equivalised household income quintile.
Children in the highest income quintiles were
least likely to be obese (14% in the highest
two quintiles for boys, 12%-13% in the highest
three quintiles for girls), whereas the
proportion obese was highest among those in
the lowest quintiles (20% in the lowest
quintile for boys, 17-18% in the lowest
quintiles for girls). Similarly, the proportion of
children who were overweight including obese
generally increased as income quintile
decreased, ranging from 26% of boys and
24% of girls in the highest quintile to 35% of
boys in the lowest quintile and 30-33% of girls
in the lowest three quintiles
3.4 Obesity and overweight
prevalence by parental BMI
Overweight and obesity prevalence among
children varied by parental BMI status. The
HSE 20074 (which remains the most up to date
source) found that obesity prevalence rates
among children were higher in households
where both natural parents or lone natural
parent were classed as either overweight or
obese.
Table 8.5 on page 239 of the HSE 2007 report
shows how mean BMI, overweight and obesity
prevalence varied by parental BMI status.
Twenty-four per cent of boys aged 2-15 living
in overweight/obese households were classed
as obese compared with 11% in normal /
underweight households. Equivalent figures
for girls classed as obese were 21% and 10%.
24 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
3.5 Obesity and Physical
Activity
Table 5.20 on page 157 of the HSE 20085
report (which remains the most up-to-date
source) shows the proportion of children who
were sedentary for more than four hours on a
typical weekday or weekend day according to
BMI categories. Among both boys and girls
there was a relationship between sedentary
time and BMI category, which is also shown in
Figure 5I on page 132 of the HSE 2008 report.
For boys, on weekdays, the proportion who
spent 4 or more hours doing sedentary
activities was 35% for those who were not
overweight or obese, 44% of those classed as
overweight and 47% of those classed as
obese. For girls, a similar pattern was found;
37%, 43% and 51% respectively.
Table 6.6 on page 177 of the HSE 2008 report
shows average daily physical activity profile,
by BMI category based on accelerometry data
(an objective measure of physical activity).
This shows that there is no difference in the
activity profile according to whether
participants were overweight or obese.
However, it should be noted that the small
base sizes for some of these categories limits
the scope for detailed analysis. Further
information on children’s physical activity
linked to obesity can be found in Chapter 5 of
this report.
3.6 Regional, national and
international comparisons
Statistics derived from the National Child
Measurement Programme (NCMP) in
England, enables us to make regional
comparisons. Obesity prevalence ranged from
8.1% in South Central Strategic Health
Authority (SHA) to 11.1% in London SHA for
Reception and from 16.5% in South Central
SHA to 21.9% in London SHA for Year 6.
The NHS Information Centre provides an
online database of results by PCT. Maps in
Figures 11 and 12 on pages 27 and 28 of the
2010/11 NCMP publication show child obesity
prevalence rates in Reception class and Year
6 by Primary Care Trust (PCT). Obesity
prevalence varied, ranging from 6.4% in
Richmond and Twickenham PCT to 14.6% in
City & Hackney PCT for Reception; and from
10.7% in Richmond and Twickenham PCT to
26.4% in Southwark PCT for Year 6.
National information for Scotland and Wales
can be found from their own health surveys.
Child Obesity information for Scotland can be
found in Chapter 7 from page 165 and Tables
7.2, 7.4 and 7.5 on pages 173 to 181 of the
Scottish Health Survey 2010.6 This reports
that obesity prevalence for all children aged 215 fell marginally in 2010 to 14.3% from 15%
the previous year. The prevalence of obesity in
boys increased from 13.0% in 1998 to 15.6%
in 2010, with some fluctuations in the 20082010 period. For girls, the prevalence was
13.1% in 1998 and 12.9% in 2010, with
some fluctuations in the intervening years
(12.3%-14.7%).
The prevalence of overweight including
obesity for children aged 2-15 in 2010 was
29.9% (31.1% for boys compared to 28.5% for
girls).
Child obesity information for Wales can be
found in Section 6 on pages 89 to 95 and
Tables 6.1 to 6.6 on pages 96 to 99 of the
Welsh Health Survey 2010.7 It shows that
around a third of children were classified as
overweight or obese, including around a
fifth of children classified as obese (36% and
19% respectively). Boys were slightly more
likely to be obese than girls (23% compared to
16%) with the combined overweight or obese
figure for boys being 38% (34% for girls).
Details of the methodologies used by each
country are contained within the publications.
These will need to be considered when
attempting comparisons.
In 2011, The Organisation for Economic Cooperation and Development (OECD) published
Health at a Glance 20118 which includes data
on overweight and obese populations across
different countries. Based on latest available
health surveys which measure height and
weight, a fifth of children aged 5-17 are
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
25
overweight or obese across all OECD and
emerging countries. In Greece, the United
States and Italy this figure is around one in
three. In contrast, China, Korea and Turkey
show overweight or obese figures of 10% or
less. In most countries, boys have higher
rates of overweight and obesity than girls,
although girls do tend to have higher rates in
Nordic countries (Sweden, Norway and
Denmark), as well as in the United Kingdom,
the Netherlands and Australia.
The OECD reports that in many developed
countries, child obesity rates doubled between
the 1960’s and 1980’s and doubled again
since then and that even in emerging
countries, the prevalence of obesity is rising,
particularly in urban areas.
Figure 2.4.1 on page 57 of the OECD report
shows the prevalence of overweight and
obesity in OECD and emerging countries
among school aged children (aged 5-17
years), and figure 2.4.2 presents the
prevalence of overweight and obesity for 6-9
year old children. This shows that there are
crucial differences among children who are
overweight or obese, not only across countries
but also according to their age. In general,
older children have higher prevalence of
overweight and obesity than younger children.
3.7 Attitudes to and
knowledge of physical
activity by BMI status
At the time the data were collected the
Government recommended that children
should do at least 60 minutes of moderate
physical activity everyday of the week. In order
to assess awareness of the recommended
guidelines for physical activity for their age
group, children aged 11 to 15 were asked in
the HSE 2007 (which remains the most up to
date source) how many days a week and how
many minutes a day young people should
spend doing physical activity. Table 8.7 on
page 240 of the HSE 2007 report shows
children’s knowledge (those aged 11-15) of
the number of days and minutes a day they
should do physical activity. In 2007, 73% of
boys who were classed as obese said that
children should spend a minimum of five days
a week doing physical activity, compared to
62% of those in the healthy BMI category.
There were no significant differences found
amongst girls.
When looking at the number of minutes per
day children should be spending doing
physical activity, 64% of boys in the healthy
BMI category thought that children should
spend at least 60 minutes a day doing physical
activity, compared with 53% of those in the
overweight category. Among girls, the
proportion who thought that children should
spend at least 60 minutes a day doing physical
activity was higher in the overweight group:
62% among those classed as overweight
compared with 50% in the healthy BMI
category.
Children aged 11 to 15 were also asked how
they perceived their own level of physical
activity compared with other children of their
own age, and to state whether they would like
to do more physical activity than at present.
Figure 8D on page 228 of the HSE 2007 report
show that 46% of boys in the healthy BMI
category believed that they were very
physically active. This compares with 37% of
those in the overweight group and 27% in the
obese group. Among girls, 32% in the normal
weight group believed that they were very
physically active compared with 21% of those
in the obese group.
Table 8.8 on page 241 of the HSE 2007 report
shows the proportion of children stating they
would like to do more physical activity than at
present was higher in the obese group than in
the healthy BMI category: 71% and 57%
respectively for boys, 84% and 71% for girls.
In the HSE 2009, children aged 8-15 were
asked about their perception of their weight.
They were asked whether or not they thought
they were about the right weight, and whether
they were trying to change their weight. Table
11B on page 193 of the HSE 2009 shows that
75% of boys and 41% of girls who were
overweight considered that they were about
the right weight, and 33% of boys and 22% of
26 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
girls who were obese did so, suggesting that
there was a lack of awareness of a weight
problem among some children.
3.8 The future
There are various research reports and journal
articles available that use HSE data to predict
future obesity trends in children. The report by
Foresight at the Government Office for
Science, Tackling Obesities: Future Choices9
includes some predictions for the future
prevalence of obesity among young people
under the age of 20. This report uses the
International Obesity Task Force (IOTF)
definition of obesity. More information on the
IOTF can be found in Appendix B. The report’s
predictions suggest a growth in the prevalence
of obesity among people under 20 to 10% by
2015 and to 14% by 2025 based on HSE 2004
data. However, these figures should be viewed
with caution due to the widening confidence
intervals on the extrapolation.
Another research report published in the
British Medical Journal Group in 2009, Time
trends in childhood and adolescent obesity in
England from 1995 to 2007 and projections of
prevalence to 201510 reveals that the 2015
projected obesity prevalence is 10.1% in boys
and 8.9% in girls, and 8.0% in male and 9.7%
in female adolescents. Predicted prevalence in
manual social classes is higher than in nonmanual classes. The report concludes that if
the trends in young obesity continue, the
percentage and numbers of young obese
people in England will increase noticeably by
2015 and the existing obesity gap between
manual and non-manual classes will widen
further.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
27
References
1. Health Survey for England, 2010. The
NHS Information Centre, 2011. Available
at:
http://www.ic.nhs.uk/pubs/hse10report
2. The National Child Measurement
Programme 2010/11: The NHS Information
Centre, 2011. Available at:
www.ic.nhs.uk/ncmp
3. Health Survey for England, 2010: Child
Trend Tables. The NHS Information
Centre, 2011. Available at:
www.ic.nhs.uk/pubs/hse10trends
4. Health Survey for England, 2007. The NHS
Information Centre, 2008. Available at:
www.ic.nhs.uk/pubs/hse07healthylifestyles
5. Health Survey for England, 2008. The NHS
Information Centre, 2009. Available at:
http://www.ic.nhs.uk/statistics-and-datacollections/health-and-lifestyles-relatedsurveys/health-survey-for-england/healthsurvey-for-england--2008-physical-activityand-fitness
6. The Scottish Health Survey 2010, Volume
1: Main Report. The Scottish Government,
2011. Available at:
http://www.scotland.gov.uk/Publications/20
11/09/27084018/91
7. The Welsh Health Survey, 2010. Welsh
Assembly, 2011. Available at:
http://wales.gov.uk/docs/statistics/2011/11
0913healthsurvey10en.pdf
8. OECD: Health at a Glance 2011, OECD
Indicators. Available at:
http://www.oecd.org/dataoecd/6/28/491058
58.pdf
9. Tackling Obesities: Future Choices –
Modelling Future Trends in Obesity and
Their Impact on Health. Foresight,
Government Office for Science, 2007.
Available at:
http://www.bis.gov.uk/assets/bispartners/fo
resight/docs/obesity/17.pdf
10. Stamatakis et al (2010). Time trends in
childhood and adolescent obesity in
England from 1995 to 2007 and projections
of prevalence to 2015. Journal of
Epidemiology and Community Health, 64:
167-174. Available at:
http://jech.bmj.com/content/64/2/167.abstr
act
28 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
4
Physical activity among adults
4.1 Background
The health benefits of a physically active
lifestyle are well documented and there is a
large amount of evidence to suggest that
regular activity is related to reduced
incidence of many chronic conditions.
Physical activity contributes to a wide range
of health benefits and regular physical
activity can improve health outcomes
irrespective of whether individuals achieve
weight loss.
Current physical activity recommendations
for adults are that they should achieve a
total of at least 30 minutes of at least
moderate activity, either in one session or in
multiple bouts of at least 10 minutes
duration, on five or more days of the week.1
Moderate activity can be achieved through
walking, cycling, gardening and housework,
as well as various sports and exercise (see
Appendix B for further details).
The main source of data used to monitor
adults’ physical activity is the Health Survey
for England (HSE). The HSE reports on
adults’ physical activity in the four weeks
prior to interview by examining overall
participation in activities and by describing
frequency of participation and type of
activity. The HSE is used as the primary
source to measure progress towards
achieving physical activity guidelines. The
most recent HSE that included questions
about physical activity and fitness was
20082 when physical activity and fitness
was the main focus of the report. In
addition to the self-reported questionnaire,
independent measures of physical activity
were recorded in the week following the
interview. Physical activity was recorded
using accelerometry. Accelerometers
measure the duration, intensity and
frequency of physical activity for each
minute they are worn by the participant,
allowing an objective and accurate
estimation of activity to be recorded. Fitness
levels were also measured using a step
test. The HSE reports from 2008 to 2010
did not include questions of people’s
perceptions and attitudes towards physical
activity, therefore, results from the HSE
20073 remain the latest available.
The Taking Part Survey (TPS)4 is a national
survey of private households in England
which began in mid-July 2005. It is a
comprehensive study on how people enjoy
their leisure time. Results from the survey
include estimates on the prevalence of
participation in active sport and reasons
given for engagement and non-engagement
in sporting activities.
The National Travel Survey (NTS) 20105
provides information on personal travel in
Great Britain, published by the Department
for Transport, and is used in this chapter to
look at the frequency of trips made by
bicycle and on foot.
The Active People Survey, published by
Sport England, provides information on
participation in sport and recreation. It
provides the measurements for National
Indicator 8 (NI8) – adult participation in
sport and active recreation, as well as
providing measurements for the cultural
indicators NI9, NI10 and NI11. This is an
annual survey, first undertaken in 2005/06
and the latest survey presents data for
2010/116. Part of the Sport England Sport
Strategy 2008-11 is a commitment to getting
one million more people taking part in more
sport by 2012/13.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
29
4.2 Meeting physical activity
guidelines
The latest information on whether physical
activity guidelines are being met is derived
by summarising different types of activity
into a frequency-duration scale. It takes into
account the time spent participating in
physical activities and the number of active
days in the last week. In the HSE, the
summary levels are divided into three
categories: Meets recommendations is
defined as 20 or more occasions of
moderate or vigorous activity of at least 30
minutes duration in the last four weeks (i.e.
at least five occasions per week on
average). This category corresponds to the
minimum activity level required to gain
general health benefits (e.g. reduction in the
relative risk for cardiovascular morbidity).
Some activity is defined as 4 to 19
occasions of moderate or vigorous activity
of at least 30 minutes duration in the last
four weeks (i.e. at least one but fewer than
five occasions per week on average). Low
activity is defined as fewer than 4 occasions
of moderate or vigorous activity of at least
30 minutes duration in the last four weeks
(i.e. less than once per week on average).
4.2.1 Self-reported physical activity
Self-reported physical activity in adults aged
16 and over is presented in Chapter 2: Selfreported physical activity in adults, pages 21
to 58 of the HSE 2008. Key findings from
the chapter are:
•
In 2008, 39% of men and 29% of
women aged 16 and over met the
government’s recommendations for
physical activity, compared with 32%
and 21% respectively in 1997.
•
There was a clear association between
meeting the physical activity
recommendations and body mass index
(BMI) category. Forty six per cent of
men and 36% of women who were
neither overweight nor obese met the
recommendations, followed by 41% of
men and 31% of women who were
overweight and only 32% of men and
19% of women who were obese.
Further information is available in Chapter
2: Self-reported physical activity in adults,
of the HSE 2008 and includes information
on the types of activities people carry out,
the average number of hours of physical
activity respondents have done in the past
week and the proportion of people meeting
recommended physical activity guidelines
by equivalised household income (Table 2.3
on page 46), Strategic Health Authority
(SHA) (Table 2.2 on page 45) and
spearhead PCT status (Table 2.4 on page
46).
The Active People Survey 2010/11,
measures the number of adults aged 16
and over in England who participate in at
least 30 minutes of sport and active
recreation at moderate intensity at least
three times a week. This survey includes
additional information on participation in
sports by age, gender, ethnicity, socioeconomic classification and region. It also
presents information on the types of sports
people participate in and how participation
levels have changed since the start of this
survey.
A key finding from this report is that in
2010/11, 6.927 million adults (4.245 million
men and 2.682 million women) participated
in sport and active recreation three times a
week for 30 minutes.
The key finding of the latest Taking Part
Survey (TPS), 2011/12 quarter 2, is that
54.0 per cent of adults had participated in
active sport at least once in the last 4
weeks. 25.8 per cent had participated in 30
minutes of moderate intensity sport at least
three times in the last week, with the
corresponding figure of 43.0 per cent at
least once in the last week.
30 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
The TPS 2011/12 quarter 2 report contains
further information on the participation in
sport on pages 23 to 25.
4.2.2 Objective measures of physical
activity
Objective measures of physical activity in
adults aged 16 and over are given in
Chapter 3: Accelerometry in adults, in the
HSE 2008. Accelerometers were used to
independently measure physical activity
over the seven day period following the
completion of the self-reported physical
activity questionnaire. The accelerometers
record information on the frequency,
intensity and duration of physical activity in
one minute epochs. Full details are
available in the HSE 2008 pages 62 to 66.
Some key findings from the chapter are:
•
Based on the results of the
accelerometer study, 6% of men and
4% of women achieved the
government’s recommended physical
activity level.
•
Men and women aged 16 to 34 were
most likely to reach the recommended
physical activity level (11% and 8%
respectively), the proportion of both men
and women meeting the
recommendations fell in the older age
groups.
•
On average men spent 31 minutes in
moderate or vigorous activity (MVPA) in
total per day and women an average of
24 minutes. However, most of this was
sporadic activity, and only about a third
of this was accrued in bouts of 10
minutes or longer which count towards
the government recommendations.
Full details of the objective measures of
physical activity can be found in Chapter 3:
Accelerometry in adults, of the HSE 2008
on pages 59 to 88. Included within this
chapter is information on the activity
patterns for adults on weekdays and
weekend days, analyses by BMI (page 68
and Table 3.6), gender and age; as well as
a comparison between the self-reported
physical activity and the objective measures
(pages 70 to 71 and Tables 3.10 to 3.12).
4.3 Physical fitness
Low levels of cardiovascular fitness are
associated with increased risk of many
health conditions. Chapter 4: Physical
fitness in adults, on pages 89 to 116 of the
HSE 2008, presents information on
cardiovascular fitness in adults aged 16 to
74 collected using a step test and
monitoring participants’ heart rate during
and after the test. This test measured the
maximal oxygen uptake (VO2max). Oxygen
uptake increases rapidly on starting
exercise; maximal oxygen uptake is
achieved when the amount of oxygen
uptake into the cells does not increase,
despite a further increase in intensity of
exercise. Full details of the step test, the
measures of physical fitness and the
definitions used in this section can be found
in Chapter 4: Physical fitness in adults, on
pages 91 to 95 of the HSE 2008.
Physical fitness has been measured only
once before on a nationally-representative
sample in England. In 1990, the Allied
Dunbar National Fitness Survey (ADNFS),7
tested participants’ fitness on a treadmill, by
measuring VO2max. The information in the
HSE 2008 was analysed to allow
comparisons to be made between the HSE
2008 and the ADNFS and this involved
converting the results of the step test from
the HSE to indicate the percentage of adults
who could sustain walking at 3 miles per
hour (mph) on the flat and on 5% incline.
The key findings from this chapter are:
•
Men had higher cardiovascular fitness
levels than women, with an average
level of VO2max of 36.3 ml O2/min/kg for
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
31
men and 32.0 ml O2/min/kg for women.
In both sexes, the mean VO2max
decreased with age.
•
•
•
Cardiovascular fitness was lower on
average among those who were obese
(32.3 ml O2/min/kg among men and 28.1
ml O2/min/kg among women) than
among those who were neither
overweight nor obese (38.8 ml
O2/min/kg and 33.9 ml O2/min/kg
respectively).
Virtually all participants were deemed
able to walk at 3 mph on the flat but
84% of men and 97% of women would
require moderate exertion for this
activity. Thirty two per cent of men and
60% of women were not fit enough to
sustain walking at 3 mph up a 5%
incline. Lack of fitness increased with
age.
Physical fitness was related to selfreported physical activity. Average
VO2max decreased, and the proportion
classified as unfit increased, as selfreported physical activity level
decreased.
Full details of the physical fitness in adults
in 2008 can be found in the Chapter 4:
Physical fitness in adults, of the HSE 2008.
Details of physical fitness in adults in 1990
can be in the ADNFS report and the key
findings are:
•
Seven out of 10 men and 8 out of 10
women fell below their age appropriate
activity level.
•
One in 6 people reported having done
no activities for 20 minutes or more at a
moderate or vigorous level in the
previous four weeks.
4.4 Participation in different
activities
4.4.1 Occupational activity
Adults aged 16 to 74 who had worked (paid
or voluntary) in the last four weeks were
asked about their moderate intensity
physical activity during work, as part of the
HSE 2008. Respondents were asked about
time spent sitting or standing, walking
around, climbing stairs or ladders and lifting,
carrying or moving heavy loads. Some of
the key findings are:
•
Men spent slightly more time than
women sitting and/or standing, climbing
stairs and/or ladders and carrying or
moving heavy loads. Men and women
spent similar amounts of time walking
around.
•
Twenty four per cent of men and 11% of
women reported doing at least 30
minutes of moderate or vigorous activity
in total whilst at work each day, thus
meeting the government
recommendations for physical activity
solely from their work.
•
Most men (62%) and women (59%)
considered themselves to be very or
fairly active at work.
Self-reported levels of physical activity
during work hours are discussed in Chapter
2: Self-reported physical activity in adults,
section 2.4.2 on page 33 and Table 2.9 on
pages 53 and 54 of the HSE 2008, including
age and gender breakdowns of the different
types of occupational physical activity.
4.4.2 Non-occupational activity
Participation in different activities, outside of
work, was collected for all adults aged over
16, as part of the HSE 2008. Physical
32 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
activities were grouped into four main
categories: walking, heavy housework,
heavy manual/ gardening/ DIY and sports
and exercise. Some key findings are:
•
•
•
The most common activity for men was
sports and exercise (51% had
participated in the past four weeks) and
the least common was heavy manual/
gardening/ DIY (28% had participated in
the past four weeks).
The most common activity for women
was heavy housework (59% had
participated in the past four weeks)
whilst the least common was heavy
manual/ gardening/ DIY (12% had
participated in the past four weeks).
On average men had participated in
non-occupational physical activity on
13.9 days in the past four weeks,
compared with 12.2 days for women.
•
Full details of walking and cycling can be
found in the complete set of annual NTS
tables, charts and maps in the National
Travel Survey (NTS) 2010.
The Active People Survey 2010/11 monitors
participation in 32 sports in England and
tracks changes in the recorded levels of
participation over time. In this survey
participation is defined as the number of
adults (aged 16 and over) who have taken
part in the sport at moderate intensity for 30
minutes or more at least once in the last
week.
•
Full details of participation in nonoccupational physical activity can be found
in Chapter 2: Self-reported physical activity
in adults, pages 21 to 58 and Tables 2.7
and 2.8 on pages 49 to 52 of the HSE 2008.
The National Travel Survey (NTS) 2010
reports on the frequency of travel by
different modes of transport including
walking and cycling. Respondents were
asked how often they took walks of 20
minutes or more without stopping, for any
reason. The NTS also asks respondents
about cycling, access to bicycles, and
frequency and length of cycle journeys.
Some of the key findings from this report
are:
•
•
In 2010, 41% of respondents (aged 2+)
said they made walks of 20 minutes or
more at least 3 times a week and a
further 23% said they did so at least
once or twice a week.
Twenty per cent of respondents
reported that they took walks of at least
20 minutes “less than once a year or
never”.
In 2010, 15% of respondents said they
ride a bicycle at least once a week and
a further 10% said they did so at least
once a month whilst 66% said they use
a bicycle less than once a year or never.
In 2010/11, the most common sports
that people had participated in were
swimming (2,809,300 participants),
football (2,117,000 participants) and
athletics (1,899,400 participants).
Further details of the number of people
participating in each sport and how this has
changed since 2007/08 can be found in the
Active People Survey 2010/11.
The Taking Part Survey in 2005/068 and
2006/079 included information on the ten
most popular activities that adults took part
in at least once in the previous 4 weeks.
•
In both 2005/06 and 2006/07, swimming
was the most popular activity with
15.7% of respondents in 2005/06 and
14.5% of respondents in 2006/07 having
participated in the previous 4 weeks.
Further details can be found in the TPS
2005/06 Chapter 8: Active Sport pages 75
to 83 and TPS 2006/07, section 2.7 on
pages 7 and 8.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
33
4.5 Geographical patterns in
physical activity
Figure 4.1 Adults’ participation in sport 2010/11
England
Percentages
Percentage of adults participating
Quartile Classifications:
4.5.1 Physical activity levels by
Strategic Health Authority
18.1% to 26.1% (high)
16.5% to <18.1% (middle-high)
14.7% to <16.5% (low-middle)
8.9% to <14.7% (low)
The HSE 2008 contains information on selfreported physical activity by Strategic
Health Authority (SHA) in Chapter 2: Selfreported physical activity in adults, Table
2.2 on page 45. The percentage of adults
doing the recommended levels of physical
activity varied by SHA, but no particular
region stood out.
4.5.2 Sport and active recreation by
Local Authority
Within the Active People Survey 2010/11,
information is collected on Adult’s
participation in sport and active recreation at
Local Authority (LA) level.
Figure 4.1 shows the proportion of adults
who participated in moderate intensity
activity for 30 minutes at least three times a
week, in each LA.
Detailed results of activity levels by LA can
be found within the Active People Survey
2010/11.
1.The sports participation indicator measures the number of adults (aged 16 and over)
participating in at least 30 minutes of sport at moderate intensity at least three times a week.
It does not include recreational walking or infrequent recreational cycling but does include
cycling if done at least once a week at moderate intensity and for at least 30 minutes. It also
includes more intense/strenuous walking activities such as power walking, hill trekking,
cliff walking and gorge walking.
Data sources: ONS Boundary Files 2008, The Active People Survey 09/10. Sport England
© Crown copyright. All rights reserved (100044406) (2011)
© The Health and Social Care Information Centre.
© 2011 re-used with the permission of Sport England.
4.5.3 Physical Activity levels in
Scotland and Wales
The Scottish Health Survey 201010 contains
information on self-reported physical activity
in adults in Scotland. The key finding
regarding meeting government physical
activity recommendations is that in 2010,
39% of adults aged 16 and over reported
meeting the government’s
recommendations for physical activity in
Scotland. Forty five per cent of men and
33% of women reported meeting the
recommendations.
Full details of physical activity in Scotland
can be found in the Scottish Health Survey
2010, Chapter 6: Physical Activity.
The Welsh Health Survey 201011 contains
information on the self-reported physical
activity levels of adults in Wales. The key
finding regarding meeting government
physical activity recommendations is:
34 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
•
In Wales, in 2010, 30% of adults
reported meeting the recommended
levels of physical activity in the last
week. A higher proportion of men than
women reported meeting the
recommendations (37% and 24%
respectively).
Further details of physical activity can be
found in the Welsh Health Survey 2010,
Chapter 4: Health-related lifestyle, section
4.6: Physical activity on page 55 and Table
4.2 on page 68.
more hours than women (44% of men
and 39% of women).
•
On average, both men and women
spent 2.8 hours watching television per
weekday. Men averaged 3.2 hours of
watching television on weekend days
and women averaged 3.0 hours.
•
Average total sedentary time varied by
BMI category. The proportion of women
who spent more than four hours per
weekday and weekend day increased
as BMI category increased, this was
also the case for men on weekend days.
•
Accelerometry data for adults shows
that in 2008, those who were not
overweight or obese spent fewer
minutes on average in sedentary time
(591 minutes for men, 577 minutes for
women) than those who were obese
(612 minutes for men, 585 minutes for
women).
4.6 Sedentary time
Sedentary time is at least as important as
moderate intensity physical activity as a
disease risk factor. Sedentary behaviour is
not merely the absence of physical activity;
rather it is a class of behaviours that involve
low levels of energy expenditure. Sedentary
behaviours are associated with increased
risk of obesity and cardiovascular disease
independently of moderate to vigorous
activity levels.12 In England, in 2002,
physical inactivity was estimated to cost at
least £2 billion and maybe up to £8.2 billion
a year and does not include the contribution
of physical inactivity to obesity estimated at
£2.5 billion annually13.
Chapters 2: Self-reported physical activity in
adults, and 3: Accelerometry in adults of the
HSE 2008 asked adults about the amount
of time they spent in sedentary pursuits
including time spent watching television,
other screen time, reading and other
sedentary activities. Some key findings from
these chapters are:
•
Average total sedentary time combines
both time spent watching the television
and other sedentary time. Similar
proportions of men and women were
sedentary for six or more hours on
weekdays (32% and 33% respectively).
However, on weekend days, men were
more likely to be sedentary for six or
Full details of the sedentary time of adults
are available in Chapter 2: Self-reported
physical activity in adults, sections 2.4.3 and
2.4.4 and Tables 2.10 and 2.11 of the HSE
2008. Objective measures of sedentary time
were collected by the accelerometers and
these results are discussed in Chapter 3:
Accelerometry in adults, Tables 3.2 to 3.6 of
the HSE 2008.
4.7 Knowledge and
attitudes towards physical
activity
In the Chapter 4: Adult physical activity:
knowledge and attitudes, on pages 69 to
106 of the HSE 2007, adults were asked
about their perceptions and attitudes to
physical activity including adults’ awareness
of recommended physical activity levels,
whether respondents believe they are
achieving recommended levels and barriers
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
35
to partaking in physical activity. Some key
findings from this chapter are:
•
Around a quarter of adults (27% of
men and 29% of women) thought
they knew the current
recommendations for physical
activity in 2007. Fewer than 1 in 10
adults specified a level equivalent to
the minimum target for physical
activity.
•
A high proportion of both men and
women aged 16 to 64 perceived
themselves to be either very or fairly
physically active compared with
other people their own age (75% of
men and 67% of women).
•
In 2007, women were slightly more
likely than men to want to be more
physically active than at present
(69% and 66% respectively).
•
Men and women were found to have
different barriers to doing more
activity. Men were most likely to cite
work commitments as a barrier to
increasing their physical activity
(45%), while lack of leisure time was
the barrier most cited by women
(37%).
Further information can be found in Chapter
4: Adult physical activity: knowledge and
attitudes, of the HSE 2007. This includes
differences in attitudes and perception by
gender and age (Tables 4.1 to 4.5, 4.8, 4.9,
4.12, 4.13 and 4.16), SHA (Tables 4.6, 4.10
and 4.14) and equivalised household
income (Tables 4.7, 4.11 and 4.15).
36 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
References
1. At least 5 a week: Evidence on the impact
of physical activity and its relationship to
health – A report from the Chief Medical
Officer. The Department of Health, 2004.
Available at:
www.dh.gov.uk/en/Publicationsandstatistic
s/Publications/PublicationsPolicyAndGuida
nce/DH_4080994
2. Health Survey for England – 2008:
Physical Activity and Fitness. The NHS
Information Centre, 2009. Available at:
www.ic.nhs.uk/pubs/hse08physicalactivity
3. Health Survey for England 2007. The NHS
Information Centre, 2008. Available at:
www.ic.nhs.uk/pubs/hse07healthylifestyles
4. The Taking Part Survey 2011/12 quarter 2.
The Department for Culture, Media and
Sport, 2011. Available at:
http://www.culture.gov.uk/publications/873
4.aspx
5. The National Travel Survey 2010. The
Department for Transport, 2011. Available
at:
http://www.dft.gov.uk/statistics/releases/nat
ional-travel-survey-2010/
6. The Active People Survey, 2010/11. Sport
England. Available at:
http://www.sportengland.org/research/activ
e_people_survey/aps5.aspx
7. Allied Dunbar National Fitness Survey.
Sports Council and Health Education
Authority, 1995. Available at:
http://www.esds.ac.uk/findingData/snDescr
iption.asp?sn=3303
8. Taking Part: The National Survey of
Culture, Leisure and Sport, Annual Report
2005/2006.The Department for Culture,
Media and Sport, 2007. Available at:
http://www.culture.gov.uk/reference_library
/publications/3682.aspx
9. Taking Part: The National Survey of
Culture, Leisure and Sport, Annual Report
2006/2007.The Department for Culture,
Media and Sport, 2008. Available at:
http://webarchive.nationalarchives.gov.uk/
+/http://www.culture.gov.uk/reference_libra
ry/publications/5396.aspx
10. The Scottish Health Survey 2010, Volume
1: Main Report. The Scottish Government,
2011. Available at:
http://www.scotland.gov.uk/News/Releases
/2011/09/27102058
11. The Welsh Health Survey, 2010. Welsh
Assembly, 2011. Available at:
http://wales.gov.uk/topics/statistics/publicat
ions/healthsurvey2010/?lang=en
12. Stamatakis E, Hirani V, Rennie K.
Moderate-to-vigorous physical activity and
sedentary behaviours in relation to body
mass index-defined and waist
circumference-defined obesity. British
Journal of Nutrition, 2009;101:765-773.
Available at:
http://www.ncbi.nlm.nih.gov/pubmed/18680
630
13. Physical activity and health - facts and
figures, Sustrans. Available at:
http://www.sustrans.org.uk/what-wedo/active-travel/active-travel-informationresources/physical-activity-and-healthfacts-and-figures
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
37
5
Physical activity among children
5.1 Introduction
The main source of data used in this
chapter is the Health Survey for England
(HSE). The HSE gathers information on the
physical activity levels of children aged 2 to
15. In the HSE 2008,1 in addition to selfreported physical activity, objective
measures of physical activity were also
collected using accelerometry data for
children aged 4 to 15. The HSE 2008
gathered information on self-reported
participation in physical activities excluding
the time spent at school. The HSE 2008 is
still the most up to date source of
information on self-reported and objective
measures of physical activity so has been
included again in this publication.
Other sources of data used in this chapter
include the Taking Part Survey (TPS),2 PE
and Sport Survey3 and the National Travel
Survey.4 The TPS collects data about
engagement and non-engagement in
culture, leisure and sport, showing how
people enjoy their leisure time. The PE and
Sport Survey collects information about
levels of school sport in schools taking part
in the School Sport Partnership Programme
in England, while the National Travel
Survey is designed to provide a databank
of personal travel information for Great
Britain.
This chapter provides an overview of the
published data on physical activity in
children and links to other data sources.
5.2 Meeting physical
activity guidelines
At the time the data was collected the Chief
Medical Officer (CMO) of England
recommended that children and young
people should do a minimum of 60 minutes
of at least moderate intensity physical
activity each day.
In the HSE 2008, the summary levels for
activity of children and young people are
divided into three levels: meets
recommendations, some activity and low
activity. Meets recommendations, formerly
called ‘high’ in earlier HSE reports, is
defined as children doing at least 60
minutes of at least moderate intensity
activity on all 7 days in the last week.
Some activity, formerly ‘medium activity’ in
previous HSE reports, is defined as 30 to
59 minutes of moderate or greater intensity
activity on all 7 days in the last week. Low
activity is defined as children who do fewer
than 30 minutes of moderate activity on
each day, or moderate activity of 60
minutes or more on fewer than 7 days in
the last week.
5.2.1 Self-reported physical activity
Self-reported physical activity levels in
children aged 2 to 15 are given in Chapter
5: Self-reported physical activity in children,
pages 117 to 157 of the HSE 2008.
Overall, in 2008, a higher proportion of
boys (32%) than girls (24%) were classified
as meeting the government’s
recommendations for physical activity.
Among girls the proportion meeting the
recommendations generally decreased with
age, ranging from 35% in girls aged 2 to
12% among those aged 14. There was a
less consistent pattern with age among
boys.
Chapter 5: Self-reported physical activity in
children, Tables 5.1 to 5.5 on pages 138 to
140 of the HSE 2008 gives more detailed
information on children’s self-reported
activity levels including activity levels by
38 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Strategic Health Authority (SHA), body
mass index (BMI), equivalised household
income and Spearhead Primary Care Trust
(PCT) status.
A discussion of physical activity and obesity
is included within Chapter 3 of this report
which covers Obesity among Children.
5.2.2 Objective measures of
physical activity
Objective measures of physical activity in
children aged 4 to 15 along with the
methods of collection are given in Chapter
6: Accelerometry in children, pages 159 to
180 of the HSE 2008. Accelerometers were
used to independently measure physical
activity over a 7 day period by recording
frequency, intensity and duration of
physical activity in one minute epochs.
Based on the results of the accelerometer
study, more boys than girls were classified
as meeting the government’s
recommendations for physical activity (33%
and 21% respectively). These objective
findings are similar to those of the selfreport study. However, the accelerometers
showed that there was considerable
variation by age. For boys aged 4 to 10,
51% met the government
recommendations but only 7% of boys
aged 11 to 15 had met these
recommendations. For girls the pattern was
similar, although fewer met the
recommendations in either age group.
Among girls aged 4 to 10, 34% had met the
recommended target, whereas in this study
none of the girls aged 11 to 15 had done
so.
(section 6.4.2, page 164 and Table 6.3),
analyses by BMI category (Table 6.6),
equivalised household income (Tables 6.4
and 6.8) and Spearhead PCT status
(Section 6.5, page 166 and Tables 6.10
and 6.11). This chapter also contains
further comparisons of the results observed
in the self-reported and objective measures
of activity.
The Taking Part Survey collects data on
participation in culture, leisure and sport.
From 2006 the survey was extended to
include children aged 11 to 15 and in
2008/09 the sample was further increased
to include children aged 5 to 10.
In 2010/11, 85% of 5-10 year olds had
taken part in sports activities outside of
school time in the last four weeks.
Meanwhile, 95% of 11-15 year olds have
taken part in sporting activities both in and
out of school in the last four weeks. In both
the 5-10 and 11-15 age groups, boys were
more likely to have done sport in the last 4
weeks than girls.
A competitive sport topic was introduced in
January 2011. In January to March of that
year, almost two thirds (64%) of 5-10 year
olds played sport at school in organised
competitions (such as a sports day).
Meanwhile, 44 per cent of 11-15 year olds
had participated in competitive sport in this
way. For 11-15 year olds, playing sport
against others in PE and games lessons
(75%) was the most common way of doing
competitive sport, whilst being a member of
a club that plays sport (32%) was the least
common.
Full details are presented from pages 14 22 of the 2010/11 Taking Part Statistical
Release.
Full details of the objective measures of
physical activity in children are provided in
Chapter 6: Accelerometry in children, of the
HSE 2008 including information on the
activity patterns of children and young
people for weekdays and weekend days
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
39
5.3 Types of physical
activity
5.3.1 Travel to / from school
In recent years, travelling to and from
school has been recognised as an
opportunity for children to achieve part of
their recommended daily physical activity.
The HSE 2008 included questions on how
children travel to and from school.
•
•
Almost two thirds of children aged 2 to
15 who had attended school, nursery or
playgroup in the last week had walked
to or from school on at least one day in
the last week (63% of boys and 65% of
girls).
5.3.2 Other types of physical activity
The HSE 2008 asks children about
participation in formal sports, for example
swimming, football, tennis and gymnastics
and informal activities including kicking a
ball around, running about and playing
active games. Time spent in walking
(excluding to and from school) was
included as a separate category of activity.
•
Ninety-five per cent of boys and girls
had participated in any physical activity
in the past week.
•
More girls than boys had participated in
walking in the last week (65% and 61%
respectively).
•
More boys than girls had participated in
formal sports (49% and 38%
respectively) and in informal activities
(90% of boys and 86% of girls).
More boys than girls cycled to or from
school on at least one day in the last
week (5% of boys compared to 2% of
girls).
Further details are provided in Chapter 5:
Self-reported physical activity in children,
section 5.4.1 on page 126 and Tables 5.7
to 5.9 on pages 142 and 143 of the HSE
2008.
The National Travel Survey (NTS) 2010
presents data on travel to/from school for
children aged 5 to 16. This includes
information on the number of trips to and
from school by walking and cycling per
child per year, for the years 1995/1997 to
2010 (Table NTS0613). Figures for 2010
suggest that 41% of 5-16 year olds’ main
method of getting to and from school is
walking, while the main method for 33% of
this age group is being driven to school in a
car / van. Just 2% used a bike to travel to
school as their main mode of transport.
Chapter 5: Self-reported physical activity in
children, of the HSE 2008 includes full
details of the activities children participate
in, including information on the number of
days and hours of participation and
analyses by age, gender (Tables 5.10 to
5.12 on pages 144 to 148), equivalised
household income (Table 5.14 on page150)
and Spearhead PCT status (Table 5.15 on
page 150).
The Taking Part Survey 2010/115 includes
information on the top 10 sports activities
carried out by children.
•
The most popular sports activities
carried out by children aged 5 to 10,
outside school hours was swimming,
diving or lifesaving with 48%
participating in the previous four weeks,
followed by football (including five-aside) (36%) and cycling or riding a bike
(including BMX and mountain biking)
(28%).
40 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
•
For children aged 11 to 15 the most
popular sports activities participated in
the past four weeks both in and out of
school were football (including five-aside) (50%), basketball (including minibasketball) (27%) and swimming, diving
or lifesaving (27%).
•
A competitive Sport topic was
introduced in January 2011. In January
to March of that year, 80% of 5-15 year
old children reported they had done
some form of competitive sport in the
last 12 months. Around three quarters
(75%) had taken part in competitive
sport in school, whilst 41% had taken
part outside of school.
•
In January to March 2011, almost a
third (30%) of 11-15 year olds belonged
to a sports club, making this the most
common means of doing competitive
sport outside school. Over a fifth (23%)
played for a sports team.
Further details are provided in Tables 2.2
on page 19 and 2.3 on page 20, and
Figures 2.6 on page 21 and 2.8 on page 22
of the 2010/11 Taking Part Survey.
The National Travel Survey reports on the
frequency of different types of travel
including walking and cycling. This report
shows that in Great Britain 2010, 68% of
children aged 2 to 16, reported walking for
20 minutes or more, at least once a week.
Full details are available within the
Transport Statistics Bulletin, National
Travel Survey 2010.
5.4 Participation in Physical
Education and school sport
The PE and Sport Survey 2009/10 (which
followed on from the ‘School sports
survey’), aimed to collect information about
the levels of participation in physical
education (PE) and school sport in schools
taking part in the School Sport Partnership
programme in England. In total 21,436
schools and further education (FE) colleges
took part in the survey between May and
July 2010. This Survey measured the takeup of 3 hours of high-quality PE and out-ofhours school sport in a typical week. This
release was last published in September
2010 and is currently discontinued.
5.4.1 Participation in PE and school
sport
The key findings from the survey show that
in 2009/10, 55% of pupils in years 1-13 of
participating schools took part in at least 3
hours of high quality PE and out of hours
school sport in a typical week.
Among the three types of schools that were
surveyed (primary, secondary and special),
64% of pupils in primary schools, 46% of
pupils in secondary schools and 64% of
pupils in special schools reported
participating in at least three hours of high
quality PE and out of hours school sport in
a typical week.
5.4.2 Time spent on PE and school
sport
The PE and Sport Survey covers physical
activity both as part of the curriculum and
activities that take place outside of school
hours, for example school sports clubs.
The key findings show that overall; pupils in
years 1 to 13 in the schools surveyed spent
an average of 117 minutes in a typical
week in 2009/10 on curriculum PE. The
long term trend shows an increase in the
average number of minutes pupils take part
in PE each week. In 2004/05 the average
number of minutes for Years 1 – 11 was
107, compared to 123 in 2009/10. For the
first time data was collected by gender and
showed that slightly more boys (80%) took
part in at least 120 minutes of curriculum
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
41
PE compared to girls (78%). In Years 1 – 6
there is no difference between the sexes,
but on entry to secondary school a
difference emerges. At Year 7 this
difference is only two percentage points
(89% of girls participate in at least two
hours of curriculum PE, compared to 91%
of boys), rising gradually to reach a four or
five percentage point differential in Years
10, 11, 12 and 13.
The PE and Sport Survey 2009/10 includes
full details of the amount of time children in
partnership schools spend in PE and out of
hours school sport (Chapter 3, pages 9 to
22) including gender patterns (Figure 15
page 22), the types of sports children
participate in (Chapter 5, pages 32 to 34),
participation in intra- and inter-school
competitive activities (Chapter 4, pages 23
to 31) and links to other clubs and
organisations (Chapter 6, pages 35 to 36).
5.5 Parental participation
The HSE 2008 collected information on
parental activity levels which allow analysis
of children’s physical activity by parental
physical activity. Parental physical activity
was classified into three categories, as with
children’s, though the definitions were
different (see Chapter 4 for definitions). The
key findings show that:
•
•
A greater proportion of fathers than
mothers reached the then government
physical activity recommendations
based on self-reported data (46% and
38% respectively).
Among boys aged 2 to10, more met the
physical activity recommendations for
children if their parents did so for adults.
Among boys aged 11 to 15 the same
pattern was apparent for their fathers’
activity levels but not for mothers’.
Similarly, among both age groups, more
boys were in the low activity category if
their parents were also in this group.
•
Among girls, the activity level of parents
made relatively little difference to the
proportion meeting recommendations,
but those who had parents with low
activity levels were considerably more
likely to be in the low activity category
themselves.
Further details of the influence of parental
participation in physical activity on
children’s physical activity are given in
Chapter 5: Self-reported physical activity in
children, section 5.3.3, pages 125 and 126
and Table 5.6 on page 141 of the HSE
2008.
5.6 Sedentary behaviour
Sedentary time is at least as important as
moderate physical activity as a disease
factor. Sedentary behaviour is not merely
the absence of physical activity; rather it is
a class of behaviours that involve low levels
of energy expenditure.
The HSE 2008 asked children about the
amount of time spent in sedentary pursuits
including time spent watching television,
other screen time, reading and other
sedentary pursuits.
In Chapter 5: Self-reported physical activity
in children, of the HSE 2008, self-reported
sedentary time is presented and the key
findings show:
•
The amount of time spent in sedentary
pursuits was similar for boys and girls
on weekdays (excluding time at school),
with both boys and girls spending 3.4
hours in sedentary pursuits. Both boys
and girls spent more time in sedentary
pursuits on weekend days (4.1 hours
for boys and 4.2 hours for girls).
•
The pattern of sedentary behaviour
differed with the age of children and
42 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
between weekdays and weekend days.
On weekdays, there was little variation
among younger children, with fewer
than 10% of those aged 2 to 9 years
being sedentary for six or more hours
per day, while the percentage rose
steeply after this age. At weekends, the
percentage that were sedentary for six
or more hours generally increased
across all age groups from 8% of boys
and girls aged 2 to 40% of boys and
41% of girls aged 15.
Full details of the sedentary time of children
and young people are available in Chapter
5: Self-reported physical activity in children,
section 5.4.3, pages 130 to 132 of the HSE
2008. Details include analyses of
sedentary time by Strategic Health
Authority (SHA) (Table 5.17), BMI status
(Table 5.20), equivalised household income
(Table 5.18) and Spearhead PCT status
(Table 5.19). Objective measures of
sedentary time were collected for children
aged 4 to 15 by the accelerometers; these
are discussed in Chapter 6: Accelerometry
in children on pages 159 to 180 of the HSE
2008.
and a further 8% of boys and 3% of
girls overestimated the minimum
recommendations.
•
Most children perceive themselves as
being either very or fairly physically
active compared with children their own
age (90% of boys and 84% of girls
respectively).
•
Girls were more likely than boys to want
to do more physical activity (74% and
61% respectively). When asked about
activities they would like to do more of
in the future, boys most frequently
mentioned ball sports (39%), riding a
bike and swimming (both 35%),
whereas girls were most likely to
mention swimming (47%).
Full details on the behaviour, knowledge
and attitudes towards physical activity are
provided in Chapter 9: Children’s physical
activity, behaviour, knowledge and
attitudes, pages 251 to 278 of the HSE
2007.
5.7 Attitudes and
perceptions to physical
activity
In the HSE 2007,5 (which remains the most
up to date source) children aged 11 to 15
were asked about their knowledge and
attitudes to physical activity. Information
was collected on children’s knowledge of
how much physical activity they should do
related to recommended physical activity
targets, perception of their own physical
activity levels and their desire to do more
physical activity. The key findings from
HSE 2007 showed that:
•
When asked how much physical activity
children should do, only one in 10
children aged 11 to 15 suggested that it
should be 60 minutes or more each day
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
43
References
1. The Health Survey for England – 2008:
Physical Activity and Fitness. The NHS
Information Centre, 2009. Available at:
www.ic.nhs.uk/pubs/hse08physicalactiv
ity
2. This Cultural and Sporting Life: The
Taking Part 2010/11 Adult and Child
Report, Statistical Release, The
Department for Culture, Media and
Sport, 2011. Available at:
http://www.culture.gov.uk/images/resea
rch/taking-part-Y6-child-adult-report.pdf
3. The PE and Sport Survey 2009/10. The
Department for Children, Schools and
Families, 2010. Available at:
http://education.gov.uk/publications/sta
ndard/publicationDetail/Page1/DFERR032
4. The National Travel Survey 2010. The
Department for Transport, 2011.
Available at:
http://assets.dft.gov.uk/statistics/release
s/national-travel-survey-2010/nts201001.pdf
5. The Health Survey for England 2007.
The NHS Information Centre, 2008.
Available at:
www.ic.nhs.uk/pubs/hse07healthylifesty
les
44 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
6
Diet
6.1 Introduction
Poor diet and nutrition are recognised as
major contributory risk factors for ill health
and premature death. This chapter
describes information available about
purchases and consumption of food and
drink among both adults and children. Most
of this information comes from three major
national surveys; the Living Costs and
Food Survey (LCF), the National Diet and
Nutrition Survey (NDNS) and the Health
Survey for England (HSE).
The LCF survey collects information on the
type and quantity of food and drink
purchased in households. The LCF survey
was previously known as the Expenditure
and Food Survey (EFS). It was renamed in
2008 when it became a module of the
Integrated Household Survey (IHS).
Findings from the survey are published
annually in the Family Food report, by the
Department for Environment, Food and
Rural Affairs (DEFRA), with Family Food
20101 being the most recent edition. The
LCF is conducted throughout the year
(January to December) across the whole of
the UK.
The NDNS2 results were published from the
first two years (combined) of a new rolling
programme of a continuous cross-sectional
survey of the food consumption, nutrient
intakes and nutritional status of people
aged 18 months and older living in private
households in the UK. The NDNS involves
an interview, a four-day dietary diary and
collection of blood and urine samples. The
previous NDNS had collected data on
consumption for 19 to 64 year olds over a
period of seven days in Great Britain which
was conducted in 2000/20013. The last
NDNS for those aged 4 to 18 years was
carried out in 1997.4
The report of years 1 and 2 combined of
the new NDNS rolling programme (April
2008 to March 2010)2 focuses on food
consumption and nutrient intakes for adults
aged 19 to 64 years and 65 years and over.
This is also presented for children aged 18
months to 3 years, 4 to 10 years and 11 to
18 years. Intakes are compared with
government recommendations and
comparisons with findings from previous
surveys are also made.
Data on fruit and vegetable consumption
among both adults and children are taken
from the HSE as this source is used to
monitor the Government’s ‘5 a day’ target,
encouraging people to eat at least five
portions of fruit and vegetables a day. Data
presented in this chapter are taken from the
HSE 20075, HSE 20086, HSE 20097 and
HSE 2010.8
6.2 Adults’ diet
6.2.1 Trends in purchases and
expenditure on food and drink
Estimates of expenditure and quantities of
food and drink purchased and brought into
the household have been collected since
the mid 1970s by the National Food Survey
(1974 to 2000), the Expenditure and Food
Survey (EFS) (2001/02 to 2007) and
subsequently the LCF (since 2008).
Family Food 2010 presents trends in UK
purchases and expenditure on food and
drink, based on the LCF. Table 1.1 on page
3 of this report shows quantities of
household purchases of food and drink in
the UK between 2007 and 2010. Table 1.3
on page 6 shows expenditure on food and
drink over the same period. Chapter 5 on
pages 51 to 56 presents some analysis on
how the rises in food prices in 2010 have
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
45
affected spending patterns. Some key
findings were:
Britain, for all age groups studied. The
analyses did not identify any new nutritional
problems in the general population.
•
Household purchases of fruit fell by
0.9% in 2010 and are now 11.6% lower
than 2007.
•
Household purchases of vegetables
increased by 0.4% in 2010 but are 2.9%
lower than 2007.
•
Since 2009, purchases of fresh fruit fell
by 0.8%, fresh green vegetables fell by
4.5% and fruit juices fell by 2.1%.
Chapter 5 on Dietary intakes from the
Headline results of the NDNS Years 1 & 2
of the Rolling Programme (2008/2009 –
2009/2010) show the key findings of
consumers’ diet over a 4 day diary period
between February 2008 and March 2010.
Table 5.3 shows vegetable, fruit, meat and
fish consumption (including from composite
dishes). The main findings from the report
show that:
•
The average weekly expenditure on all
household food and drink in 2010 was
£27.57 per person (this was £26.75 per
person in 2009), after a 3.1% rise in
food prices. There have been significant
upward trends in household
expenditure on eggs, butter, beverages
and sugar and preserves.
•
Adults (aged 19 to 64 years), consumed
on average 4.2 portions of fruit and
vegetables per day and older adults
(aged 65 years and over) consumed 4.4
portions. Thirty per cent of adults and
37% of older adults met the ‘five-a-day’
recommendation
•
Boys aged 11-18 years, on average,
consumed 3.1 portions of fruit and
vegetables per day and 13% met the
‘five a day’ recommendation. Girls in
the same age group consumed 2.7
portions per day and 7% met the
recommendation.
•
Mean saturated fat intakes for all age
groups exceeded the recommended
level of no more than 11% of food
energy. The mean saturated fat intake
for adults aged 19 to 64 years was
12.8% of food energy.
•
Mean intakes of trans fatty acids
provided 0.7-0.9% of food energy for all
age groups, which was within the
recommendation of no more than 2%
food energy.
•
Mean intakes of non-milk extrinsic
sugars (NMES) exceeded the
recommendation of no more than 11%
of food energy for children aged 4 to 10
years (14.4% food energy), children
aged 11-18 years (15.7% food energy)
and adults aged 19 to 64 years (12.6%)
Family Food 2010 also presents some
regional analysis of food purchases using a
3 year average. Table 3.4 on page 30
shows purchases of selected food groups
by Government Office Region. Some
findings were:
•
Household purchases of vegetables
(excluding potatoes) were highest in the
South West and lowest in the North
West (1,241 and 974 grams per person
per week respectively).
•
Household purchases of fruit were
highest in London and lowest in the
North East (1,337 and 944 grams per
person per week respectively).
6.2.2 Consumption of food and drink
by age and gender
Results from years 1 and 2 (combined) of
the rolling NDNS programme showed that
diet and nutrient intakes of the UK
population were largely similar to findings
from previous assessments of diet in Great
46 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
•
61% of adults (aged 19-64) and 53% of
older adults (aged 65 years and over)
consumed alcohol during the four-day
diary. Adults who had consumed
alcohol obtained 9% of energy intake
from alcohol in the 19 to 64 age group
and 6% in the 65 years and over group.
standardised by equivalised household
income and Tables 8.5 and 8.6 (pages 150)
show the same information by Spearhead
status and sex. Some key findings in 2009
were:
•
Higher consumption was also
associated with higher income, and vice
versa: 32% of men and 37% of women
in the highest income quintile had
consumed five or more portions in
2009, but only 18% of men and 19% of
women in the lowest quintile had done
so.
•
The proportion of adults eating five or
more portions of fruit and vegetables
per day was higher among adults in
non-Spearhead Primary Care Trusts
(PCTs) (27% of men and 31% of
women) than in Spearhead PCTs in
2009 (20% of men and 23% of women).
6.2.3 Fruit and vegetable
consumption
The HSE Adult trend tables were updated
in 2010 for fruit and vegetable
consumption. Fruit and vegetable
consumption is measured in portions per
day for HSE, based on consumption in the
day before the interview. Portions are
expressed in everyday units such as whole
or half fruit and tablespoons or bowls, to
make it easier for participants to recall their
consumption accurately. Some key findings
in 2010 were:
•
•
25% of men and 27% of women
consumed the recommended five or
more portions of fruit and vegetables
daily in 2010 (26% of adults). These
results are similar to those reported in
2009, and are slightly lower than in
2006, when 28% of men and 32% of
women consumed at least five portions
daily.
Women continued to be more likely
than men to consume five or more
portions of fruit and vegetables a day in
2010. Consumption varied with age
among both sexes, being lowest among
those aged 16-24 (19% of men and
21% of women this age ate five or more
portions).
More detailed data on consumption of fruit
and vegetables was last reported in
Chapter 8 on pages 137 to 144 of the HSE
2009 report.9 Tables 8.1 and 8.2 (pages
146 and 147) show daily consumption and
types of fruit and vegetables consumed by
age and sex, Tables 8.3 and 8.4 (pages
148 and 149) show these data age
Scotland and Wales carry out their own
health surveys. Fruit and vegetable
consumption can be found in Section 5.3
on pages 117 to 121 of the Scottish Health
Survey 2010.10 Similarly, fruit and
vegetable consumption can be found in
Section 4.5 on pages 54 of the Welsh
Health Survey 2010.11
In 2010, the percentage of adults
consuming the recommended five or more
portions of fruit and vegetables daily was
22% in Scotland and 35% in Wales. This
compares with 26% for England.
6.2.4 Knowledge and attitudes
Chapter 5 on pages 107 to 147 of the HSE
2007 report (this is the most up-to-date
source) asked respondents about their
knowledge of and attitudes towards diet
and healthy eating. Tables 5.7 and 5.8
(pages 133 and 134) present data on
knowledge of fruit and vegetable
guidelines, Tables 5.10 and 5.11 (pages
136 and 137) show data on perceptions of
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
47
per person per day. Eating out
accounted for an average of 11% of
energy intake per person in 2010.
diet, Tables 5.12 to 5.16 (pages 138 to
143) on attitudes to healthy eating and
Table 5.17 (page 144) on barriers to
improving diet. Some key findings were:
•
•
A higher proportion of women (78%)
than men (62%) correctly stated that
five portions of fruit and vegetables
should be consumed per day.
•
The majority of participants believed
their own diet to be ‘quite’ healthy (71%
for men and 72% for women). Women
were more likely to consider that they
had a ‘very’ healthy diet compared with
men (19% and 16% respectively) and
less likely to report their diet as being
‘not very healthy/very unhealthy’ (8% of
women and 12% of men).
•
The majority of men and women agreed
with the statements ‘Healthy foods are
enjoyable’ (66% of men and 80% of
women) and ‘I really care about what I
eat’ (64% of men and 74% women).
Few agreed that ‘Healthy eating is just
another fad’ (10% of men and 8% of
women.
Family Food 2010 also presents some
country and regional analysis of energy
intake, using data covering the combined
years 2008-2010. Table 3.2 on pages 2627 shows energy and nutrient intakes by
country and Table 3.6 shows the same
information by Government Office Region.
Some findings were:
•
Total energy intake was lowest in
England (2,264 kcal per day) compared
to Scotland, Wales, and Northern
Ireland which had similar intakes (2,357
2,353 and 2,332 kcal per day
respectively).
•
Total energy intake was highest in the
South West (2,396 kcal per day) and
lowest in London (2,171 kcal per day).
6.2.5 Energy and macronutrients
from food and drink
Trends in energy and nutrient intake are
available from Chapter 2 of Family Food
2010. Key findings are:
•
•
Based on food purchases, total energy
intake per person fell 0.5% in 2010.
Although the downward movement
since 2007 is not statistically significant
there is a clear picture of a longer term
downward trend. Total energy intake for
2010 was 2,292 kcal per person per
day (2,303 in 2009).
Energy from eating out fell sharply
between 2006 and 2008 although with
rises in 2009 and 2010 there is no
evidence of a downward trend. Average
energy intake from eating out was 3.8%
lower in 2010 than in 2007 at 258 kcal
There was a small increase (0.2%) in
the total intake of sodium in 2010
although levels are still 0.6% lower than
in 2007. Eating out accounted for 12%
of sodium intakes, broadly in line with
eating out as a percentage of total
energy intake. Despite a rise of 5.2% in
2010, eating out intake remains 2.5%
lower than in 2007. Major contributors
to household intake of sodium in 2010
include; ‘non-carcase meat and meat
products’, bread and ‘other cereals and
cereal products’.
6.3 Children’s diet
6.3.1 Consumption of food and drink
The new NDNS Rolling Programme covers
children as well as adults. The report of
years 1 and 2 combined (2008/09-2009/10)
focuses on food consumption and nutrient
intakes for children aged 18 months to 3
48 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
children aged four to 10 years and from
31g to 20g per day (35% decrease) for
children aged 11 to 18 years; a lower
percentage of children in both age
groups were consuming these foods.
years, 4 to 10 years and 11 to 18 years.
Some of the findings include:
•
•
Consumption of brown, granary and
wheatgerm bread, which includes 50:50
breads (bread made from a mixture of
white and whole grain flour), was higher
in children aged four to 10 years than
seen in the previous survey.
For children aged four to 18 years there
was a fall in the average consumption
of other (non-high fibre) breakfast
cereals. For children aged 11 to 18
years there was also a fall in the
consumption of high fibre breakfast
cereals whilst for children aged four to
10 years consumption had risen,
meaning there was little change in total
breakfast cereal consumption in
children aged four to 10 years, but a
decrease in children aged 11 to 18
years. A higher percentage of four to 10
year olds were consuming high fibre
breakfast cereals than seen in the
previous survey.
•
Semi-skimmed milk was the most
commonly consumed type of milk for all
age groups except those aged 1.5 to
three years for whom whole milk was
the most commonly consumed type of
milk.
•
Average consumption of fruit was
highest in children aged 1.5 to three
years (102g per day) compared with
that for children aged four to 10 years
(96g per day) and 11 to 18 years (62g
per day).
•
•
Compared with the last survey of this
age group in 1997, consumption of
vegetables (excluding potatoes) was
higher for children aged four to 10
years.
Compared with the last survey of this
age group in 1997, average
consumption of sugar and chocolate
confectionery was reduced from 30g to
18g per day (39% decrease) for
6.3.2 Fruit and vegetable
consumption
The latest HSE 2010 Child Trend Tables12
(Table 7) shows that between 2009 and
2010, the percentage of 5-15 year old boys
consuming 5 or more portions of fruit and
vegetables decreased from 21% to 19%.
For 5-15 year old girls the corresponding
percentages showed a similar decrease
from 22% to 20%. Overall, the mean
number of portions consumed was 3.2
portions for boys and 3.3 portions for girls
in 2010.
Further detailed information on the
consumption of fruit and vegetables among
children aged 5 to 15 years are given in
chapter 14 on pages 333 to 348 of volume
1 of the HSE 2008. Tables 14.1 to 14.3
(pages 342 to 345) show daily consumption
and types of fruit and vegetables consumed
by age and sex, Table 14.4 (page 346)
shows daily consumption by Strategic
Health Authority (SHA) and Table 14.5
(page 347) by equivalised household
income. Some key findings in 2008 were:
•
Fresh fruit was the most commonly
eaten item. More girls than boys
reported eating fresh fruit the previous
day (72% of girls and 68% of boys).
The consumption of fresh fruit was
related to age, with younger children
consuming more fresh fruit than older
children.
•
A higher proportion of boys and girls
living in the South Central SHA
consumed five or more portions of fruit
and vegetables per day than children in
other regions (25% of boys compared
with 15%-23% in other regions and
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
49
portions of fruit and vegetables should
be consumed each day. However, only
22% of boys and 21% of girls could
correctly identify what a portion was.
33% of girls compared with 13%-24% in
other regions).
•
Boys and girls living in households in
the highest income quintile were the
most likely to meet the ‘5 a day’
recommendations (27% of boys and
30% of girls). There was little variation
among those in the lower quintiles (from
16% to 19% of boys and 17% to 20% of
girls).
6.3.3 Knowledge and attitudes
Chapter 10 on pages 279 to 308 of the
HSE 2007 report (this remains the most upto-date source) asked children aged
between 11 and 15 about their knowledge
of and attitudes towards diet and healthy
eating. Tables 10.6 and 10.7 (page 300)
show data on knowledge of fruit and
vegetable consumption, Table 10.8 (page
301) on perception of diet, Tables 10.9 to
10.13 (pages 302 to 306) on attitudes to
healthy eating and Tables 10.14 and 10.15
(page 307) on factors affecting
improvement in diet. Some key findings in
2007 were:
•
•
More than four in five children regarded
their diet as healthy with most saying it
was ‘quite healthy’ (70% of boys and
72% of girls) rather than ‘very healthy’
(13% of both boys and girls). Only 1%
thought that their diet was ‘very
unhealthy’.
The majority of children aged 11-15 agreed
that ‘Healthy foods are enjoyable’ (72% of
girls and 64% of boys). There was a more
even spread of agreement, disagreement
and neutral views about the statement ‘The
tastiest foods are the ones that are bad for
you’.
Around two in three boys and three in
four girls accurately reported that five
50 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
References
1.
Family Food 2010, Department for
Environment, Food and Rural Affairs,
2011. Available at:
http://www.defra.gov.uk/statistics/foodfar
m/food/familyfood/
6.
Health Survey for England 2008. The
NHS Information Centre, 2009. Available
at:
www.ic.nhs.uk/pubs/hse08physicalactivit
y
2.
National Diet Nutrition Survey: headline
results from years 1 and 2 (2008/2009 –
2009/2010), Department of Health. 2011.
Available at:
http://www.dh.gov.uk/en/Publicationsand
statistics/Publications/PublicationsStatisti
cs/DH_128166
7.
Health Survey for England 2009. The
NHS Information Centre, 2010. Available
at:
www.ic.nhs.uk/pubs/hse09report
8.
Health Survey for England 2010. The
NHS Information Centre, 2011. Available
at:
http://www.ic.nhs.uk/pubs/hse10report
9.
Health Survey for England 2010 – Adult
Trend Tables. The NHS Information
Centre, 2011. Available at:
www.ic.nhs.uk/pubs/hse10trends
10.
The Scottish Health Survey 2010,
Volume 1: Main Report. Scottish
Government, 2011. Available at:
http://www.scotland.gov.uk/Publications/
2011/09/27084018/0
11.
The Welsh Health Survey, 2010. Welsh
Government, 2011. Available at:
http://wales.gov.uk/topics/statistics/headli
nes/health2011/110913/?lang=en
12.
Health Survey for England 2010 – Child
Trend Tables. The NHS Information
Centre, 2011. Available at:
http://www.ic.nhs.uk/pubs/hse10trends
3.
4.
5.
National Diet and Nutrition Survey: adults
aged 19-64 years. Available at:
http://www.ons.gov.uk/ons/aboutons/surveys/social-surveys/ourpublications/health-and-care/nationaldiet---nutrition-survey---adults-aged-19to-64-years/index.html
National Diet and Nutrition Survey:
young people aged 4 to 18 years. The
Food Standards Agency, 2000. Available
at:
http://www.ons.gov.uk/ons/aboutons/surveys/social-surveys/ourpublications/health-and-care/nationaldiet---nutrition-survey---children-aged-4to-18-years/index.html
Health Survey for England 2007. The
NHS Information Centre, 2008. Available
at:
www.ic.nhs.uk/pubs/hse07healthylifestyl
es
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
51
7
Health outcomes
7.1 Introduction
The association between obesity and
increased risk of many serious diseases
and mortality is well documented and has
led to the National Institute for Health and
Clinical Excellence (NICE) developing
guidelines on identifying and treating
obesity.1 This chapter focuses on the
health outcomes related to being
overweight and obese.
Information from the National Audit Office2
(NAO) and a House of Commons Select
Committee report,3 is used to establish the
broad risk of death and disease associated
with obesity. Data from the Health Survey
for England 2009 (HSE 2009)4 are used to
analyse the relationships between Body
Mass Index (BMI) and waist circumference
and the prevalence of selected diseases in
the population. These data have been
analysed for this report and has not been
published before. Whist the 2010 HSE has
been published the accompanying dataset
is not available at the time of this
publication.
Data on finished admission episodes and
finished consultant episodes related to a
diagnosis of obesity are presented using
the Hospital Episode Statistics (HES)
databank5 produced by The NHS
Information Centre for health and social
care (NHS IC).
In addition information on prescription
drugs used for the treatment of obesity
from the Prescribing Unit at the NHS IC,6
including data on the number of items
prescribed and the net ingredient cost of
drugs used in the treatment of obesity are
also included. European regulators
suspended the marketing authorisation for
the weight loss drug Sibutramine in early
2010 amid concerns about a raised risk of
heart attacks and strokes. This follows the
withdrawal of the marketing authorisation
for the less prescribed obesity drug
Rimonabant in 2009 for similar reasons.
7.2 Relative risks of
diseases and death
Obesity is a major public health problem
due to its association with serious chronic
diseases such as type 2 diabetes,
hypertension (high blood pressure), and
hyperlipidaemia (high levels of fats in the
blood that can lead to narrowing and
blockages of blood vessels), which are
major risk factors for cardiovascular
disease and cardiovascular related
mortality. Obesity is also associated with
cancer, disability, reduced quality of life,
and can lead to premature death.
Figure 7.1 shows the extent to which
obesity increases the risks of developing a
number of diseases relative to the nonobese population. For example, it is
estimated that an obese woman is almost
13 times more likely to develop type 2
diabetes than a woman who is not obese.
These relative risks are based on a
comprehensive review of international
literature carried out by the NAO to provide
the best estimates that could be applied to
England (see Appendix A for more details).
The basis of the estimates varies due to
differences in the methodologies of the
studies selected, but the table gives a
broad indication of the strength of
association between obesity and each of
the diseases.
52 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Figure 7.1 Relative risk factors for obese people of
developing selected diseases, by gender
Numbers
England
Type 2 diabetes
Men
Women
5.2
12.7
Hypertension
2.6
4.2
Myocardial infarction
1.5
3.2
Cancer of the colon
3.0
2.7
Angina
1.8
1.8
Gall bladder diseases
1.8
1.8
-
1.7
Osteoarthritis
1.9
1.4
Stroke
1.3
1.3
Ovarian cancer
Source:
National Audit Office, NAO
Copyright © 2006. UK National Audit Office
The NAO estimated that in 1998 over
30,000 deaths in England were attributable
to obesity, approximately 6% of all deaths
in that year. Around 9,000 of these were
premature deaths (i.e. occurred before
state retirement age). In 2004, research by
a House of Commons Select Committee,
estimated that 34,100 deaths were
attributable to obesity. This equates to
6.8% of all deaths in England.
7.3 Relationships between
obesity prevalence and
selected diseases
Guidance published by the National
Institute for Health and Clinical Excellence
(NICE) recommends the use of waist
circumference in conjunction with BMI for
assessing the health risks associated with
being overweight or obese. A raised waist
circumference is defined as greater than
102cm in men and greater than 88cm in
women.
Appendix B. In this section, where obese
men and women or obesity is referred to it
includes morbidly obese.
7.3.1 Blood pressure
Table 1 from the HSE 2010 Adult Trend
Tables7 shows the latest trend information
on blood pressure levels by age and
gender for 2003-2010.
Within this section, the latest information on
blood pressure by BMI and waist
circumference have been updated using
data from HSE 2009 as this is the latest
data available.
Among adults aged 16 and over, the
prevalence of high blood pressure (whether
controlled with medication or not) was
found to be affected by both increased BMI
and raised waist circumference.
Table 7.1 shows that overweight men and
women were more likely to have high blood
pressure than those in the normal weight
group (30% compared to 20% in the normal
weight group for men and 26% compared
to 15% in the normal weight group for
women), while obese men and women
were most likely to have high blood
pressure (51% and 46% respectively). This
is also shown in Figure 7.2.
Figure 7.2 High blood pressure by Body Mass Index (BMI) and gender, 2009
Percentages
England
Men
Women
60
50
40
30
This section looks at the relationship
between having an increased BMI and
selected diseases and also considers the
effect of having a raised waist
circumference, using data from HSE 2009.
For further information please see
20
10
0
Normal (BMI 18.5 to less than Overweight (BMI 25 to less than
25)
30)
Obese (BMI 30 or more)
Source: Health Survey for England 2009. The NHS Information Centre
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
53
Table 7.2 shows that men with a raised
waist circumference were more than twice
as likely to have high blood pressure as
those with a waist circumference of 102cm
or less (51% compared with 23%). The
pattern was similar for women; 42% of
those with a raised waist circumference
had high blood pressure, compared with
15% of those with a waist circumference of
88cm or less.
Figure 7.3 Limiting longstanding illness by Body Mass Index (BMI) and gender, 2009
Percentages
England
Men
Women
35
30
25
20
15
10
5
7.3.2 Longstanding illness
Table 11 from the HSE 2010 Adult Trend
Tables shows the latest trend information
on general health, longstanding illness and
acute sickness by gender for 1993-2010.
Within this section, the latest information on
longstanding illness by BMI and waist
circumference has been updated using
data from HSE 2009 as this is the latest
data available.
Table 7.3 shows that, in 2009, the
prevalence of limiting longstanding illness
(whereby a longstanding illness limits the
respondents’ activity in some way) was
higher among obese men and women
(28% and 33% respectively) than those in
the normal weight group (16% and 15%
respectively). Men and women who were
obese were also more likely to report a
non-limiting longstanding illness than men
and women in the normal weight group.
This is also shown in Figure 7.3.
0
Normal (BMI 18.5 to less than
25)
Overweight (BMI 25 to less than
30)
Obese (BMI 30 or more)
Source: Health Survey for England 2009. The NHS Information Centre
Table 7.4 shows that both men and women
with a raised waist circumference were
more likely to report having a limiting
longstanding illness than those without a
raised waist circumference (29% compared
with 18% for men and 33% compared with
17% for women).
Table 7.5 shows that neither men nor
women who were either overweight or
obese score differently on the GHQ12
questionnaire (designed to measure selfassessed general health, acute sickness
leading to reduction in recent activity and
psychosocial wellbeing) than those men
and women in the normal weight group.
No recent data has been collected that
discusses cardiovascular disease, diabetes
and general health and their relationships
with BMI and waist circumference but data
using HSE 20068 can be found in chapter 7
of Statistics on obesity, physical activity
and diet: England, 20099.
54 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Data on Finished Admission Episodes
(FAEs) and Finished Consultant Episodes
(FCEs) are available from the Hospital
Episode Statistics (HES) databank from
The NHS Information Centre. This section
presents recorded FAEs in England where
there was a primary or secondary diagnosis
of obesity and recorded FCEs in England
where there was a primary diagnosis of
obesity and a main or secondary procedure
of bariatric surgery. These data are based
on the tenth revision of the International
Classification of Diseases (ICD-10).10 The
FCE data for bariatric surgery are based on
the Office for Population, Censuses and
Surveys: Classification of Intervention and
Procedures, 4th Revision (OPCS-4)
codes.11 The most recent data available are
for the financial year 2010/11.
HES data is available from 1989-90
onwards. During this time there have been
ongoing improvements in data quality and
coverage, which particularly affect earlier
data years. As well as this, there have been
a number of changes to the classifications
used within HES records. Changes in NHS
practice also need to be borne in mind
when analysing time series. This may be
particularly relevant for admissions with a
primary or secondary diagnosis where
some of the increases may be attributable
to changes in recording practice.
within the year. In this chapter an FAE is
referred to as a ‘hospital admission’.
Table 7.6 shows that in 2010/11 there were
11,574 hospital admissions with a primary
diagnosis of obesity among people of all
ages. This is over ten times as high as the
number in 2000/01 (1,054) and more than
double three years earlier (5,018).
Over the period 2000/01 to 2010/11, in
almost every year, more than twice as
many females were admitted to hospital
than males, with a primary diagnosis of
obesity (Figure 7.4).
Figure 7.4 Finished Admission Episodes with a primary diagnosis of obesity, by gender,
2000/01 to 2010/11
Numbers
England
10,000
9,000
8,000
Females
7,000
N u m b er
7.4 Hospital Episode
Statistics
6,000
5,000
Males
4,000
3,000
2,000
1,000
0
2000/01 2001/02
2002/03 2003/04
2004/05 2005/06 2006/07
Source: Hospital Episode Statistics, HES. The Information Centre
2007/08 2008/09
2009/10 2010/11
Year
In 2010/11, the age groups with the highest
number of admissions with a primary
diagnosis of obesity were those aged 35 to
44 (3,277) and those aged 45 to 54 (3,573).
Together these two age groups accounted
for more than half of all such admissions
(Table 7.7, Figure 7.5).
7.4.1 Finished admission episodes
with a diagnosis of obesity
A Finished Admission Episode (FAE) is the
first period of inpatient care under one
consultant within one healthcare provider.
It should be noted that admissions do not
represent the number of inpatients, as a
person may have more than one admission
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
55
Figure 7.6 Finished Admission Episodes with a primary or secondary diagnosis of
obesity, by gender, 2000/01 to 2010/11
Figure 7.5 Finished Admission Episodes with a primary diagnosis of
obesity, by age, 2010/11
England
Numbers
England
Thousands
160
140
4000
120
3500
Females
100
3000
80
2500
60
2000
Males
40
1500
20
1000
0
2000/01
500
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
Source: Hospital Episode Statistics, HES. The Information Centre
0
Under 16
16-24
25-34
35-44
45-54
55-64
65-74
75 and
over
Source: Hospital Episode Statistics, HES. The Information Centre
Among Strategic Health Authorities (SHAs)
in 2010/11, over one in every five
admissions with a primary diagnosis of
obesity occurred in London SHA (2,708),
with the next highest number in East
Midlands SHA (1,623). North East SHA
had the highest rate of admissions per
100,000 of the population (40) and South
Central, South West and North West SHA
had the lowest (14). As with the national
data, more females were admitted to
hospital with a primary diagnosis of obesity
than males in each of the SHAs. Note that
admission figures cannot be used to
compare prevalence of obesity between
areas as people may travel for treatment
and treatment may be concentrated in
some areas. Also SHAs may adopt
different treatment practices (Table 7.8).
In 2010/11, there were 211,783 admissions
with a mention of obesity (i.e. a primary or
a secondary diagnosis). These data show
that obesity is far more likely to be recorded
as a secondary than a primary diagnosis.
Females are more likely than males to be
admitted to hospital with either a primary or
secondary diagnosis of obesity with
136,566 female admissions with a mention
of obesity compared to 75,190 male
admissions (but this gap between genders
is not to the same extent as for primary
diagnoses only) (Table 7.9, Figure 7.6).
Table 7.10 shows that in 2010/11, adults
aged 55 to 64 had the highest number of
recorded hospital admissions with either a
primary or secondary diagnosis of obesity
(43,754), followed by those aged 45 to 54
years (39,258) and 65 to 74 years (36,056).
This pattern differs from that for admissions
with a primary diagnosis only, where it was
shown that the highest number of
admissions occurred in those aged 45 to
54.
The North West SHA had the largest
number of admissions with either a primary
or secondary diagnosis of obesity (32,995)
and the North East SHA had the highest
admission rate (557 per 100,000
population). South Central SHA reported
the least number of admissions (10,884)
and South East Coast reported the lowest
admission rate (256 per 100,000 of the
population). The consistency of reporting
diagnoses may vary by SHA and needs to
be considered when interpreting these data
(Table 7.11).
7.4.2 Bariatric surgery
The term ‘bariatric surgery’ is used to
define a group of procedures that can be
performed to facilitate weight loss, although
these procedures can also be performed
for other conditions. It includes stomach
stapling, gastric bypasses and sleeve
gastrectomy, performed on the stomach
and/or intestines to limit the amount of food
an individual can consume. Such surgery is
56 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
used in the treatment of obesity for people
with a BMI above 40, or for those with a
BMI between 35 and 40 who have health
problems such as type 2 diabetes or heart
disease.
Table 7.12 shows the number of recorded
Finished Consultant Episodes (FCEs)
where there was a primary diagnosis of
obesity and the main or secondary
procedure was recorded as one of codes
used to define bariatric surgery for the
purpose of this report (see Appendix B for a
full list of these procedure codes). An FCE
is defined as a period of admitted patient
care under one consultant within one
healthcare provider. The figures do not
represent the number of patients as a
person may have more than one episode of
care within the same stay in hospital or in
different stays in the same year.
Surgical procedures are recorded using the
Office of Population, Censuses and
Surveys: Classification of Interventions and
Procedures, 4th Revision (OPCS-4) codes.
Operative procedure codes were revised
from 2006-07. 2010-11 data uses OPCS
4.6 codes, 2009-10 data uses OPCS 4.5
codes, 2008-09 and 2007-08 data uses
OPCS 4.4 codes, 2006-07 data uses
OPCS 4.3 codes, data prior to 2006-07
uses OPCS 4.2 codes. Results based on
the old coding system cannot be compared
with results based on the revised systems
so data for 2006/07 to 2010/11 are
presented separately from previous years.
See Appendix B for further details.
There was a year on year increase in the
number of recorded FCEs for bariatric
surgery from 261 in 2000/01 to 1,038 in
2005/06. Annually the ratio of these
recorded FCEs between men and women
remained relatively constant with around
eight in ten recorded FCEs involving female
patients (Table 7.12).
Using the new classifications, in 2010/11
there were 8,087 recorded FCEs with a
primary diagnosis of obesity and a main or
secondary procedure of bariatric surgery.
Females continue to account for the
majority of these; in 2010/11 there were
1,771 such recorded FCEs for males and
6,315 for females.
London SHA had the highest number of
recorded FCEs for bariatric surgery in
2010/11 (1,909), while South Central SHA
had the lowest (387). East Midlands SHA
had the highest number of FCEs per
100,000 of the population, this value being
32. The SHA with the lowest rate was the
North West, with 6 FCEs per 100,000 of the
population followed by East of England and
South Central SHAs with 9 FCEs per
100,000 of the population. (Table 7.13).
7.5 Prescribing
The two drugs most commonly prescribed
for the treatment of obesity by GP
practices, in England, were Orlistat
(Xenical) and Sibutramine (Reductil).
Orlistat is a capsule that prevents the
absorption of some fat in the intestine,
while Sibutramine works in the brain by
altering the chemical messages that control
how the person taking it feels and thinks
about food. This drug has now been
suspended following a European review, as
well as the less prescribed drug
Rimonabant (Acomplia), in 2009, for similar
reasons.
In 2010, there were 1.1 million prescription
items for drugs for the treatment of obesity.
Overall, the number of prescription items in
2010 was over seven times the number in
2000, when there were 157 thousand
prescription items for drugs for the
treatment of obesity. The Net Ingredient
Cost (NIC) is the basic cost of a drug, not
taking into account discounts, dispensing
costs, fees or prescription charges income.
The total NIC for drugs for the treatment of
obesity increased from £6.6 million in 2000
to £36.9 million in 2010, reaching its peak
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
57
in 2007 at £51.6 million. The NIC per item
decreased from £42 in 2000 to £33 in 2010
(which showed a slight increase until 2006
where it peaked at £45) (Table 7.14).
Almost all (98%) of the total number of
prescription items in 2010 for obesity drugs
were for Orlistat and the rest (2%) were for
Sibutramine (withdrawn during 2010)
(Figure 7.7).
Figure 7.8 Number of prescription items
dispensed for treatment of obesity per
100,000 of the population, by PCT, 2010
Number of prescription items (000s)
Quartile Classifications:
2,960 to 4,340
2,350 to <2,960
1,940 to <2,350
840 to <1,940
Figure 7.7 Number of prescription items for the main drugs used for the treatment of obesity
dispensed in primary care, 2000 to 2010
England
1,200
1,000
Orlistat
800
600
Sibutramin
400
200
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Source: Prescribing Analyses and Cost Tool (PACT) from the Prescription Pricing Division of the Business Services
Authority (PPD of the BSA).
Copyright © 2011, re-used w ith the permission of the Prescription Pricing Devision
Data sources: ONS Boundary Files 2011, Prescribing Analyses and Cost (PACT)
from the Prescription Services a division of the Business Services Authority.
© Crown copyright. All rights reserved (100044406) (2011)
© The Health and Social Care Information Centre
Table 7.15 shows prescription data for
treatment of obesity by Strategic Health
Authority. North West SHA had the
greatest number of prescription items in
total (195 thousand) and per head of
population (2.8 thousand items per
100,000). South Central SHA had the
lowest with 52 thousand items, and the
lowest per head of population at 1.25
thousand items per 100,000 population.
Figure 7.8 shows that the number of
prescription items dispensed for the
treatment of obesity per 100,000 of the
population in each primary care trust (PCT)
varies by PCT, with the lowest number of
items prescribed being predominantly in the
south west.
58 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
References
1.
2.
Obesity: the prevention, identification,
assessment and management of
overweight and obesity in adults and
children. National Institute for Health
and Clinical Excellence (NICE), 2006.
Available at:
http://www.nice.org.uk/guidance/CG4
3
Tackling Obesity in England. National
Audit Office, 2001. Available at:
www.nao.org.uk/publications/0001/tac
kling_obesity_in_england.aspx
3.
Obesity. House of Commons Health
Committee, 2004. Available at:
www.publications.parliament.uk/pa/c
m200304/cmselect/cmhealth/23/23.pd
f
4.
Health Survey for England 2009: The
NHS Information Centre, 2010.
Available at:
www.ic.nhs.uk/pubs/hse09report
5.
Hospital Episode Statistics (HES).
The NHS Information Centre, 2011.
The HES data included in this bulletin
are not routinely published, but are
available on request. Available at:
www.hesonline.org.uk
6.
Prescribing Unit. The NHS
Information Centre, 2011. The
prescription data included in this
bulletin are not routinely published but
are available on request. Available at:
http://www.ic.nhs.uk/statistics-anddata-collections/primarycare/prescriptions
7.
Health Survey for England – 2010
Trend Tables. The NHS Information
Centre, 2011. Available at:
www.ic.nhs.uk/pubs/hse10trends
8. Health Survey for England 2006:
The NHS Information Centre,
2007. Available at:
www.ic.nhs.uk/pubs/hse06cvda
ndriskfactors
9. Statistics on obesity, physical
activity and diet: England, 2009:
The NHS Information Centre,
2009. Available at:
www.ic.nhs.uk/pubs/opad09
10. International Classification of
Diseases, 10th revision (ICD-10).
World Health Organisation.
Available at:
http://www.who.int/classification
s/icd/en/
11. Office for Population, Censuses
and Surveys: Classification of
Interventions and Procedures,
4th revision (OPCS-4) codes
supplement. Health Protection
Agency, 2008. Available at:
http://www.hpa.org.uk/web/HPA
webFile/HPAweb_C/121550169
0196
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
59
List of Tables
7.1
Blood pressure level by body mass index (BMI) and gender, 2009
7.2
Blood pressure level by waist circumference and gender, 2009
7.3
Longstanding illness by body mass index (BMI) and gender, 2009
7.4
Longstanding illness by waist circumference and gender, 2009
7.5
GHQ 12 score by body mass index (BMI) and gender, 2009
7.6
Finished Admission Episodes with a primary diagnosis of obesity, by gender, 1999/2000 to
2010/11
7.7
Finished Admission Episodes with a primary diagnosis of obesity, by age group, 1999/2000 to
2010/11
7.8
Finished Admission Episodes with a primary diagnosis of obesity, by Strategic Health
Authority (SHA) of residence and gender, 2010/11
7.9
Finished Admission Episodes with a primary or secondary diagnosis of obesity, by gender,
1999/2000 to 2010/11
7.10
Finished Admission Episodes with a primary or secondary diagnosis of obesity, by age group,
1999/2000 to 2010/11
7.11
Finished Admission Episodes with a primary or secondary diagnosis of obesity, by Strategic
Health Authority (SHA) of residence and gender, 2010/11
7.12
Finished Consultant Episodes with a primary diagnosis of obesity and a main or secondary
procedure of ‘Bariatric Surgery’ by gender, 1999/2000 to 2010/11
7.13
Finished Consultant Episodes with a primary diagnosis of obesity and a main or secondary
procedure of ‘Bariatric Surgery’, by Strategic Health Authority (SHA), 2010/11
7.14
Number of prescription items, net ingredient cost and average net ingredient cost per item of
drugs for the treatment of obesity prescribed in Primary Care and dispensed in the
community, 2000 to 2010
7.15
Number of prescription items of drugs for the treatment of obesity prescribed in Primary Care
and dispensed in the community, by Strategic Health Authority (SHA), 2010
60 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Table 7.1 Blood pressure level by body mass index (BMI) and gender, 2009
Percentages
England
Total
Underweight
Normal
Overweight
Obese (including
morbidly obese)
Men
Normotensive untreated
Hypertensive controlled
Hypertensive uncontrolled
Hypertensive untreated
All with high blood pressure
68
8
6
18
32
[100]
[0]
[0]
[0]
[0]
80
3
4
13
20
70
9
5
16
30
49
12
11
28
51
Women
Normotensive untreated
Hypertensive controlled
Hypertensive uncontrolled
Hypertensive untreated
All with high blood pressure
73
7
7
13
27
[97]
[0]
[0]
[3]
[3]
85
4
3
8
15
74
7
6
12
26
54
13
13
20
46
Unweighted bases
Men
Women
1,240
1,540
10
30
310
550
550
460
290
360
Weighted bases
Men
Women
1,365
1,454
23
36
398
545
571
423
289
318
1. See Appendix B for explanations of blood pressure categories.
2. All figures are based on those with a valid blood pressure measurement.
3. BMI categories used for classifying levels of obesity are: underweight = BMI less than 18.5, normal = BMI
18.5 to less than 25, overweight = BMI 25 to less than 30, obese (including morbidly obese) = BMI 30 or more.
4. Total includes those without a valid BMI recorded.
5. Adults aged 16 and over.
6. Hypertensive controlled/uncontrolled are those who take drugs that were prescribed specifically to lower their
blood pressure.
7. All with high blood pressure are those who are hypertensive (BP >= 140/90mmHg) or not hypertensive but on
treatment that lowers blood pressure.
8. Unweighted bases have been rounded to the nearest 10.
9. [ ] Results in brackets should be treated with caution because of the low base size (below or around 50).
Source:
Health Survey for England 2009, The NHS Information Centre for health and social care.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
61
Table 7.2 Blood pressure level by waist circumference and gender, 2009
Percentages
England
Total
Non raised waist
circumference
Raised waist
circumference
Men
Normotensive untreated
Hypertensive controlled
Hypertensive uncontrolled
Hypertensive untreated
All with high blood pressure
68
8
6
18
32
77
5
4
14
23
49
15
10
26
51
Women
Normotensive untreated
Hypertensive controlled
Hypertensive uncontrolled
Hypertensive untreated
All with high blood pressure
73
7
7
13
27
85
4
3
8
15
58
12
12
19
42
Unweighted bases
Men
Women
1,240
1,540
770
830
450
680
Weighted bases
Men
Women
1,365
1,454
911
823
434
607
1. See Appendix B for explanations of blood pressure categories.
2. All figures are based on those with a valid blood pressure measurement.
3. A raised waist circumference is defined as greater than 102cm in men and greater than 88cm in
women.
4. Total includes those without a valid waist circumference recorded.
5. Adults aged 16 and over.
6. Hypertensive controlled/uncontrolled are those who take drugs that were prescribed specifically to
lower their blood pressure.
7. All with high blood pressure are those who are hypertensive (BP >= 140/90mmHg) or not hypertensive
but on treatment that lowers blood pressure.
8. Unweighted bases have been rounded to the nearest 10.
Source:
Health Survey for England 2009,The NHS Information Centre for health and social care.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
62 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Table 7.3 Longstanding illness by body mass index (BMI) and gender, 2009
Percentages
England
Total
Underweight
Normal
Overweight
Obese (including
morbidly obese)
Men
Limiting Longstanding Illness
Non limiting Longstanding Illness
No Longstanding Illness
22
20
59
[23]
[15]
[63]
16
14
70
19
20
61
28
27
45
Women
Limiting Longstanding Illness
Non limiting Longstanding Illness
No Longstanding Illness
23
19
57
[21]
[11]
[68]
15
16
69
22
22
56
33
24
43
Unweighted bases
Men
Women
2,110
2,540
30
50
520
830
840
710
450
540
Weighted bases
Men
Women
2,341
2,442
45
51
657
835
898
671
453
488
1. BMI categories used for classifying levels of obesity are: underweight = BMI less than 18.5, normal = BMI 18.5 to
less than 25, overweight = BMI 25 to less than 30, obese (including morbidly obese) = BMI 30 or more.
2. Total includes those without a valid BMI recorded.
3. Adults aged 16 and over.
4. Unweighted bases have been rounded to the nearest 10.
5. [ ] Results in brackets should be treated with caution because of the low base size (below or around 50).
Source:
Health Survey for England 2009, The NHS Information Centre for health and social care.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
63
Table 7.4 Longstanding illness by waist circumference and gender, 2009
Percentages
England
Total
Non raised waist
circumference
Raised waist
circumference
Men
Limiting Longstanding Illness
Non limiting Longstanding Illness
No Longstanding Illness
22
20
59
18
18
64
29
22
48
Women
Limiting Longstanding Illness
Non limiting Longstanding Illness
No Longstanding Illness
23
19
57
17
17
65
33
22
45
Unweighted bases
Men
Women
2,110
2,540
910
920
520
800
Weighted bases
Men
Women
2,341
2,442
1,104
920
510
722
1. A raised waist circumference is defined as greater than 102cm in men and greater than 88cm in women.
2. Total includes those without a valid waist circumference recorded.
3. Adults aged 16 and over.
4. Unweighted bases have been rounded to the nearest 10.
Source:
Health Survey for England 2009, The NHS Information Centre for health and social care.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
64 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Table 7.5 GHQ12 score by body mass index (BMI) and gender, 2009
Total
Underweight
Normal
Overweight
Percentages
Obese (including
morbidly obese)
Men
score 0
score 1-3
score 4+
58
27
15
[44]
[35]
[21]
57
28
15
59
26
14
58
28
14
Women
score 0
score 1-3
score 4+
53
29
18
[43]
[39]
[18]
59
25
16
53
31
16
50
29
21
Unweighted bases
Men
Women
1,980
2,400
30
40
510
810
820
680
440
520
Weighted bases
Men
Women
2,181
2,305
45
49
626
812
872
646
445
472
England
1. See Appendix B for explanation of GHQ12.
2. All figures are based on those with a valid GHQ12 score.
3. BMI categories used for classifying levels of obesity are: underweight = BMI less than 18, normal = BMI 18
to less than 25, overweight = BMI 25 to less than 30, obese (including morbidly obese) = BMI 30 or more.
4. Total includes those without a valid BMI recorded.
5. Adults aged 16 and over.
6. Unweighted bases have been rounded to the nearest 10.
7. [ ] Results in brackets should be treated with caution because of the low base size (below or around 50).
Source:
Health Survey for England 2009, The NHS Information Centre.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
65
Table 7.6 Finished Admission Episodes with a primary diagnosis of obesity,
by gender, 2000/01 to 2010/11
Total
Males
Numbers
Females
1,054
1,019
1,275
1,711
2,035
2,564
3,862
5,018
7,988
10,571
11,574
309
284
427
498
589
746
1,047
1,405
2,077
2,495
2,919
741
731
848
1,213
1,442
1,786
2,807
3,613
5,910
8,074
8,654
England
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
1. A finished admission episode (FAE) is the first period of inpatient care under one consultant within
one healthcare provider. FAEs are counted against the year in which the admission episode finishes.
Admissions do not represent the number of inpatients, as a person may have more than one
admission within the year.
2. The primary diagnosis is the first of up to 20 (14 from 2002-03 to 2006-07 and 7 prior to 2002-03)
diagnosis fields in the Hospital Episode Statistics (HES) data set and provides the main reason why
the patient was admitted to hospital.
3. ICD-10 Codes: E66 - Obesity.
4. Figures have not been adjusted for shortfalls in data.
5. Counts include people resident in English Strategic Health Authorites (SHAs) only, including
admissions where the SHA of residence was England but not further specified and excludes
admissions where the SHA of residence was unknown.
6. Total includes admissions where the gender was unknown.
7. HES data is available from 1989-90 onwards. During this time there have been ongoing
improvements in data quality and coverage, which particularly affect earlier data years. As well as this,
there have been a number of changes to the classifications used within HES records. Changes have
also been made to the organisation of the NHS. These need to be considered when interpreting the
accuracy and validity of time series analyses.
Source:
Hospital Episode Statistics (HES), The NHS Information Centre for health and social care.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights
reserved.
66 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Table 7.7 Finished Admission Episodes with a primary diagnosis of obesity, by age group,
2000/01 to 2010/11
Total
Under 16
16-24
25-34
35-44
45-54
55-64
65-74
Numbers
75 and over
1,054
1,019
1,275
1,711
2,035
2,564
3,862
5,018
7,988
10,571
11,574
226
237
400
579
547
583
656
747
775
632
525
45
39
65
67
107
96
184
228
322
361
375
147
134
136
174
287
341
461
564
1,013
1,348
1,425
255
240
289
391
487
637
1,069
1,469
2,359
3,132
3,277
214
199
216
273
364
554
872
1,198
2,133
3,076
3,573
96
97
94
151
174
258
459
598
1,099
1,555
1,820
56
48
52
52
36
72
118
157
221
378
456
14
21
23
24
32
20
43
53
63
87
115
England
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
1. A finished admission episode (FAE) is the first period of inpatient care under one consultant within one healthcare provider.
FAEs are counted against the year in which the admission episode finishes. Admissions do not represent the number of
inpatients, as a person may have more than one admission within the year.
2. The primary diagnosis is the first of up to 20 (14 from 2002-03 to 2006-07 and 7 prior to 2002-03) diagnosis fields in the
Hospital Episode Statistics (HES) data set and provides the main reason why the patient was admitted to hospital.
3. ICD-10 Codes: E66 - Obesity.
4. Figures have not been adjusted for shortfalls in data.
5. Counts include people resident in English Strategic Health Authorites (SHAs) only, including admissions where the SHA of
residence was England but not further specified and excludes admissions where the SHA of residence was unknown.
6. Total includes admissions where the age was unknown.
7. HES data is available from 1989-90 onwards. During this time there have been ongoing improvements in data quality and
coverage, which particularly affect earlier data years. As well as this, there have been a number of changes to the classifications
used within HES records. Changes have also been made to the organisation of the NHS. These need to be considered when
interpreting the accuracy and validity of time series analyses.
Source:
Hospital Episode Statistics (HES), The NHS Information Centre for health and social care.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
67
Table 7.8 Finished Admission Episodes with a primary diagnosis of obesity, by Strategic Health Authority (SHA)
of residence and gender, 2010/11
England
Admissions
Total
Male
England
Q30
Q31
Q32
Q33
Q34
Q35
Q36
Q37
Q38
Q39
E18000001
E18000002
E18000003
E18000004
E18000005
E18000006
E18000007
E18000008
E18000009
E18000010
North East
North West
Yorkshire and the Humber
East Midlands
West Midlands
East of England
London
South East Coast
South Central
South West
Female
Numbers
Admissions per 100,000 of population
Total
Male
Female
11,574
2,919
8,654
22
11
33
1,052
955
1,165
1,623
903
864
2,708
978
571
754
218
287
306
342
243
324
580
249
184
186
834
668
859
1,281
660
540
2,128
728
387
568
40
14
22
36
17
15
35
22
14
14
17
8
12
15
9
11
15
12
9
7
63
19
32
56
24
18
54
32
19
21
1. A finished admission episode (FAE) is the first period of inpatient care under one consultant within one healthcare provider. FAEs are counted
against the year in which the admission episode finishes. Admissions do not represent the number of inpatients, as a person may have more than
one admission within the year.
2. The primary diagnosis is the first of up to 20 (14 from 2002-03 to 2006-07 and 7 prior to 2002-03) diagnosis fields in the Hospital Episode
Statistics (HES) data set and provides the main reason why the patient was admitted to hospital.
3. ICD-10 Codes: E66 - Obesity.
4. Figures have not been adjusted for shortfalls in data.
5. Counts include people resident in English Strategic Health Authorites (SHAs) only, including admissions where the SHA of residence was
England but not further specified and excludes admissions where the SHA of residence was unknown.
6. Office for National Statistics (ONS) estimated resident population mid-2010 figures have been used to calculate admissions per 100,000
http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-231847
7. Totals include admissions where the gender was unknown.
Source:
Hospital Episode Statistics (HES), The NHS Information Centre for health and social care.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
68 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Table 7.9 Finished Admission Episodes with a primary or secondary
diagnosis of obesity, by gender, 2000/01 to 2010/11
Total
Male
Numbers
Female
22,878
23,777
29,237
33,546
40,741
52,019
67,211
80,914
102,987
142,219
211,783
8,938
9,448
12,068
13,804
16,590
21,432
27,791
32,080
39,524
52,517
75,190
13,924
14,320
17,168
19,736
24,145
30,552
39,411
48,829
63,457
89,657
136,566
England
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
1. A finished admission episode (FAE) is the first period of inpatient care under one consultant
within one healthcare provider. FAEs are counted against the year in which the admission episode
finishes. Admissions do not represent the number of inpatients, as a person may have more than
one admission within the year.
2. The primary diagnosis is the first of up to 20 (14 from 2002/03 to 2006/07 and 7 prior to
2002/03) diagnosis fields in the Hospital Episode Statistics (HES) data set and provides the main
reason why the patient was admitted to hospital. As well as the primary diagnosis, there are up to
19 (13 from 2002/03 to 2006/07 and 6 prior to 2002/03) secondary diagnosis fields in Hospital
Episode Statistics (HES) that show other diagnoses relevant to the episode of care. These figures
represent the number of episodes where the diagnosis was recorded in any of the 20 primary and
secondary diagnosis fields in the record. Each episode is only counted once in each count, even if
the diagnosis is recorded in more than one diagnosis field of the record.
3. ICD-10 Codes: E66 - Obesity.
4. Figures have not been adjusted for shortfalls in data.
5. Counts include people resident in English Strategic Health Authorites (SHAs) only, including
admissions where the SHA of residence was England but not further specified and excludes
admissions where the SHA of residence was unknown.
6. Total includes admissions where the gender was unknown.
7. The quality and coverage of HES data have improved over time. These improvements in
information submitted by the NHS have been particularly marked in the earlier years and need to
be borne in mind when analysing time series. Some of the increase in figures for later years
(particularly 2006-07 onwards) may be due to the improvement in the coverage of independent
sector activity. Changes in NHS practice also need to be borne in mind when analysing time
series. This may be particularly relevant for admissions with a primary or secondary diagnosis
where some of the increases may be attributable to changes in recording practice. Further years’
data may be required to aid interpretation of these statistics.
Source:
Hospital Episode Statistics (HES), The NHS Information Centre for health and social care.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights
reserved.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
69
Table 7.10 Finished Admission Episodes with a primary or secondary diagnosis of obesity, by age
group, 2000/01 to 2010/11
Total
Under 16
16 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to74
Numbers
75 and over
22,878
23,777
29,237
33,546
40,741
52,019
67,211
80,914
102,987
142,219
211,783
781
856
1,117
1,355
1,506
1,727
1,896
2,104
2,229
2,400
2,762
654
715
912
1,026
1,457
1,717
2,316
3,169
4,326
6,609
12,042
2,142
2,129
2,288
2,449
3,449
4,252
5,319
7,218
9,899
15,490
26,965
3,522
3,512
4,371
4,845
5,953
7,401
9,961
12,101
15,508
21,344
30,606
4,656
4,878
5,661
6,452
7,424
9,858
12,922
15,683
19,971
27,641
39,258
4,877
5,217
6,721
7,790
9,086
12,146
15,882
18,489
23,136
30,884
43,754
4,009
4,226
5,391
6,432
7,813
10,056
12,571
14,496
18,234
24,294
36,056
2,190
2,222
2,738
3,175
4,036
4,840
6,296
7,512
9,531
13,399
20,056
England
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
1. A finished admission episode (FAE) is the first period of inpatient care under one consultant within one healthcare provider. FAEs
are counted against the year in which the admission episode finishes. Admissions do not represent the number of inpatients, as a
person may have more than one admission within the year.
2. The primary diagnosis is the first of up to 20 (14 from 2002/03 to 2006/07 and 7 prior to 2002/03) diagnosis fields in the Hospital
Episode Statistics (HES) data set and provides the main reason why the patient was admitted to hospital. As well as the primary
diagnosis, there are up to 19 (13 from 2002/03 to 2006/07 and 6 prior to 2002/03) secondary diagnosis fields in Hospital Episode
Statistics (HES) that show other diagnoses relevant to the episode of care. These figures represent the number of episodes where
the diagnosis was recorded in any of the 20 primary and secondary diagnosis fields in the record. Each episode is only counted once
in each count, even if the diagnosis is recorded in more than one diagnosis field of the record.
3. ICD-10 Codes: E66 - Obesity.
4. Figures have not been adjusted for shortfalls in data.
5. Counts include people resident in English Strategic Health Authorites (SHAs) only, including admissions where the SHA of
residence was England but not further specified and excludes admissions where the SHA of residence was unknown.
6. Total includes admissions where the age was unknown.
7.The quality and coverage of HES data have improved over time. These improvements in information submitted by the NHS have
been particularly marked in the earlier years and need to be borne in mind when analysing time series. Some of the increase in
figures for later years (particularly 2006-07 onwards) may be due to the improvement in the coverage of independent sector activity.
Changes in NHS practice also need to be borne in mind when analysing time series. This may be particularly relevant for admissions
with a primary or secondary diagnosis where some of the increases may be attributable to changes in recording practice. Further
years’ data may be required to aid interpretation of these statistics.
Source:
Hospital Episode Statistics (HES), The NHS Information Centre for health and social care.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
70 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Table 7.11 Finished Admission Episodes with a primary or secondary diagnosis of obesity, by Strategic Health
Authority (SHA) of residence and gender, 2010/11
England
England
Q30
Q31
Q32
Q33
Q34
Q35
Q36
Q37
Q38
Q39
E18000001
E18000002
E18000003
E18000004
E18000005
E18000006
E18000007
E18000008
E18000009
E18000010
North East
North West
Yorkshire and the Humber
East Midlands
West Midlands
East of England
London
South East Coast
South Central
South West
Numbers
Admissions per 100,000 of population
7
Total
Male
Female
Total
Admissions
Male
Female
211,783
75,190
136,566
405
292
516
14,523
32,995
23,883
21,060
25,453
27,476
23,902
11,237
10,884
20,322
5,482
12,139
8,207
6,398
7,907
10,762
8,959
4,382
3,742
7,191
9,038
20,856
15,676
14,662
17,543
16,712
14,939
6,841
7,142
13,130
557
476
451
470
467
471
305
256
263
385
429
355
314
289
295
374
230
205
183
278
681
593
584
647
633
566
380
304
342
489
1. A finished admission episode (FAE) is the first period of inpatient care under one consultant within one healthcare provider. FAEs are counted against
the year in which the admission episode finishes. Admissions do not represent the number of inpatients, as a person may have more than one admission
2. The primary diagnosis is the first of up to 20 (14 from 2002/03 to 2006/07 and 7 prior to 2002/03) diagnosis fields in the Hospital Episode Statistics
(HES) data set and provides the main reason why the patient was admitted to hospital. As well as the primary diagnosis, there are up to 19 (13 from
2002/03 to 2006/07 and 6 prior to 2002/03) secondary diagnosis fields in Hospital Episode Statistics (HES) that show other diagnoses relevant to the
episode of care. These figures represent the number of episodes where the diagnosis was recorded in any of the 20 primary and secondary diagnosis fields
in the record. Each episode is only counted once in each count, even if the diagnosis is recorded in more than one diagnosis field of the record.
3. ICD-10 Codes: E66 - Obesity.
4. Figures have not been adjusted for shortfalls in data.
5. Counts include people resident in English Strategic Health Authorites (SHAs) only, including admissions where the SHA of residence was England but
not further specified and excludes admissions where the SHA of residence was unknown.
6. Office for National Statistics (ONS) estimated resident population mid-2010 figures have been used to calculate admissions per 100,000 population.
Information on ONS population data is available at:
http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-231847
7. Totals include admissions where the gender was unknown.
8. The quality and coverage of HES data have improved over time. These improvements in information submitted by the NHS have been particularly
marked in the earlier years and need to be borne in mind when analysing time series. Some of the increase in figures for later years (particularly 2006-07
onwards) may be due to the improvement in the coverage of independent sector activity. Changes in NHS practice also need to be borne in mind when
analysing time series. This may be particularly relevant for admissions with a primary or secondary diagnosis where some of the increases may be
attributable to changes in recording practice. Further years’ data may be required to aid interpretation of these statistics.
Source:
Hospital Episode Statistics (HES), The NHS Information Centre for health and social care.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
71
Table 7.12 Finished Consultant Episodes with a primary diagnosis of obesity and a
main or secondary procedure of 'Bariatric Surgery' by gender, 2000/01 to 2010/11
Total
Male
Numbers
Female
OPCS-4.2 procedure codes
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
261
281
345
474
744
1,038
46
38
65
96
137
200
215
241
280
378
603
808
2006/07 (OPCS-4.3 procedure codes)
2007/08 (OPCS-4.4 procedure codes)
2008/09 (OPCS-4.4 procedure codes)
2009/10 (OPCS-4.5 procedure codes)
2010/11 (OPCS-4.6 procedure codes)
1,951
2,724
4,221
7,214
8,087
381
598
969
1,450
1,771
1,562
2,126
3,251
5,762
6,315
England
1. A finished consultant episode (FCE) is a continuous period of admitted patient care under one consultant
within one healthcare provider. FCEs are counted against the year in which they end. Figures do not represent
the number of different patients, as a person may have more than one episode of care within the same stay in
hospital or in different stays in the same year.
2. The primary diagnosis is the first of up to 20 (14 from 2002-03 to 2006-07 and 7 prior to 2002-03) diagnosis
fields in the Hospital Episode Statistics (HES) data set and provides the main reason why the patient was
admitted to hospital.
3. ICD-10 Codes: E66 - Obesity.
4. These figures represent the number of episodes where the procedure (or intervention) was recorded in any of
the 24 (12 from 2002/03 to 2006/07 and 4 prior to 2002/03) operative procedure fields in a Hospital Episode
Statistics (HES) record. A record is only included once in each count, even if the procedure is recorded in more
than one operative procedure field of the record. Please note that more procedures are carried out than episodes
with a main or secondary procedure. For example, patients under going a ‘cataract operation’ would tend to
have at least two procedures – removal of the faulty lens and the fitting of a new one – counted in a single
episode.
5. The term 'bariatric surgery' is often used to define a group of procedures that can be performed to facilitate
weight loss although these procedures can be performed for conditions other than weight loss. It includes
stomach stapling, gastric bypasses and sleeve gastrectomy. The procedures for tables 7.12 and 7.13 show the
defined range of procedures when a corresponding main diagnosis of Obesity (ICD10-E66) is also present.
Definition of codes can be found in Appendix B.
6. All OPCS-4.2, OPCS-4.3, OPCS-4.4, OPCS-4.5 and OPCS-4.6 procedure codes used to define bariatric
surgery are described in Appendix B.
7. Figures have not been adjusted for shortfalls in data.
8. Counts include people resident in English Strategic Health Authorites (SHAs) only, including admissions
where the SHA of residence was England but not further specified and excludes admissions where the SHA of
residence was unknown.
9. Total includes episodes where the gender was unknown.
10. The quality and coverage of HES data have improved over time. These improvements in information
submitted by the NHS have been particularly marked in the earlier years and need to be borne in mind when
analysing time series. Some of the increase in figures for later years (particularly 2006-07 onwards) may be due
to the improvement in the coverage of independent sector activity. Changes in NHS practice also need to be
borne in mind when analysing time series.
11. Figures are based on decisions as to which operative procedures constituted 'Bariatric Surgery' at that time.
Changes to the figures over time need to be interpreted in the context of improvements in data quality and
coverage (particularly in earlier years). In particular, improvements in how 'Bariatric surgery' is coded, with the
change of codes in various versions of OPCS, means that had the previous years been based on the latest
coding advice, figures would have been slightly different and affects earlier years more.
12. Hospital coding for bariatric surgery was updated in 2009/10 so that it is now possible to identify how many
bariatric procedures were for maintenance of an existing gastric band. Nationally, of the 8,087 bariatric
procedures in 2010/11, 1,444 of these were for maintenance.
Source:
Hospital Episode Statistics (HES), The NHS Information Centre for health and social care.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
72 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Table 7.13 Finished Consultant Episodes with a primary diagnosis of obesity and a main or secondary procedure of
'Bariatric Surgery' by Strategic Health Authority (SHA), 2010/11
Numbers
England
Finished Consultant Episodes
Total
Male
England
Q30
Q31
Q32
Q33
Q34
Q35
Q36
Q37
Q38
Q39
E18000001
E18000002
E18000003
E18000004
E18000005
E18000006
E18000007
E18000008
E18000009
E18000010
North East
North West
Yorkshire and the Humber
East Midlands
West Midlands
East of England
London
South East Coast
South Central
South West
Female
Finished Consultant Episodes per 100,000 of
population
Total
Male
Female
8,087
1,771
6,315
15
7
24
549
447
837
1,426
635
505
1,909
775
387
616
112
111
210
275
153
170
335
172
103
130
437
336
627
1,151
482
335
1,574
602
284
486
21
6
16
32
12
9
24
18
9
12
9
3
8
12
6
6
9
8
5
5
33
10
23
51
17
11
40
27
14
18
1. A finished consultant episode (FCE) is a continuous period of admitted patient care under one consultant within one healthcare provider. FCEs are counted
against the year in which they end. Figures do not represent the number of different patients, as a person may have more than one episode of care within the same
stay in hospital or in different stays in the same year.
2. The primary diagnosis is the first of up to 20 (14 from 2002-03 to 2006-07 and 7 prior to 2002-03) diagnosis fields in the Hospital Episode Statistics (HES) data
set and provides the main reason why the patient was admitted to hospital.
3. ICD-10 Codes: E66 - Obesity.
4. These figures represent the number of episodes where the procedure (or intervention) was recorded in any of the 24 (12 from 2002/03 to 2006/07 and 4 prior to
2002/03) operative procedure fields in a Hospital Episode Statistics (HES) record. A record is only included once in each count, even if the procedure is recorded in
more than one operative procedure field of the record. Please note that more procedures are carried out than episodes with a main or secondary procedure. For
example, patients under going a ‘cataract operation’ would tend to have at least two procedures – removal of the faulty lens and the fitting of a new one – counted
in a single episode.
5. The term 'bariatric surgery' is often used to define a group of procedures that can be performed to facilitate weight loss although these procedures can be
performed for conditions other than weight loss. It includes stomach stapling, gastric bypasses and sleeve gastrectomy. The procedures for tables 7.12 and 7.13
show the defined range of procedures when a corresponding main diagnosis of Obesity (ICD10-E66) is also present. Definition of codes can be found in Appendix
B.
6. All OPCS-4.5 procedure codes used to define bariatric surgery are described in Appendix B.
7. Figures have not been adjusted for shortfalls in data.
8. Counts include people resident in English Strategic Health Authorites (SHA) only, including admissions where the SHA of residence was England but not further
specified and excludes admissions where the SHA of residence was unknown.
9. Office for National Statistics (ONS estimated resident population mid-2010 figures have been used to calculate FCEs per 100,000 population. Information on
ONS population data is available at:
http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-231847
10. Totals include episodes where the gender was unknown.
11. The quality and coverage of HES data have improved over time. These improvements in information submitted by the NHS have been particularly marked in
the earlier years and need to be borne in mind when analysing time series. Some of the increase in figures for later years (particularly 2006-07 onwards) may be
due to the improvement in the coverage of independent sector activity. Changes in NHS practice also need to be borne in mind when analysing time series.
Source:
Hospital Episode Statistics (HES), The NHS Information Centre for health and social care.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
73
Table 7.14 Number of prescription items, net ingredient cost and average net ingredient cost per item of drugs for the
treatment of obesity prescribed in Primary Care and dispensed in the community, 2000 to 2010
Thousands / £
England
2000
Prescription Items (thousands)
Orlistat
156
Sibutramine
Rimonabant
Total
157
Net Ingredient Cost (£ 000)
Orlistat
6,573
Sibutramine
Rimonabant
Total
6,613
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
415
53
469
540
196
737
484
203
688
492
208
699
645
226
871
774
263
23
1,060
827
294
112
1,233
848
325
106
1,278
1,080
370
1,450
1,087
22
0
1,109
17,575
2,030
19,659
23,401
7,752
31,203
21,036
8,458
29,532
21,391
9,314
30,706
27,020
10,984
38,004
32,476
13,654
1,411
47,541
32,047
13,093
6,440
51,580
29,980
9,595
5,237
44,812
36,769
10,024
46,793
36,297
595
1
36,892
Net Ingredient Cost per item (£)
Orlistat
42
42
43
43
44
42
42
39
35
34
Sibutramine
38
39
42
45
49
52
45
30
27
Rimonabant
62
58
50
Total
42
42
42
43
44
44
45
42
35
32
1. Prescriptions are written on a prescription form known as a FP10. Each single item written on the form is counted as a prescription item.
2. Net Ingredient Cost (NIC) is the basic cost of a drug. It does not take account of discounts, dispensing costs, fees or prescription charge income.
33
27
53
33
3. This information was obtained from the Prescribing Analysis and Cost Tool (PACT) system, which covers prescriptions prescribed by GPs, nurses, pharmacists
and others in England and dispensed in the community in the UK. Prescriptions written in hospitals /clinics that are dispensed in the community, prescriptions
dispensed in hospitals, dental prescribing and private prescriptions are not included in PACT data.
4. Prescriptions written in England but dispensed outside England are included.
5. Rimonabant was only available on prescription from July 2006, therefore figures for Rimonbant in 2006 only reflect six months worth of data.
6. On 16th January 2009, the European Commission issued a decision to withdraw the marketing authorisation for Rimonabant (Acomplia) following an assessment
of the benefits and risks of taking this medicine.
7. Up until 2007 'total' included other drugs that may be used to treat obesity which include Mazindol, Phentermine and Diethylpropion Hydrochloride.
8. On 21st January 2010, the European Medicines Agency (EMA) released a statement advising the suspension of sibutramine following a study which showed that
there was an increased risk of non-fatal heart attacks and strokes outweighing the benefits of this weight loss drug. Therefore, data on Sibutramine will be limited for
2010.
Source:
Prescribing Analyses and Cost (PACT) from the Prescription Pricing Division of the NHS Business Services Authority (PPD of the NHS BSA). The NHS Information
Centre.
Copyright © 2012, re-used with the permission of the Prescription Pricing Division.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
74 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Table 7.15 Number of prescription items of drugs for the treatment of obesity
prescribed in Primary Care and dispensed in the community, by Strategic Health
Authority (SHA), 2010
England
Prescription Items
(thousands)
Total
Orlistat
England
North East SHA
North West SHA
Yorkshire and the Humber SHA
East Midlands SHA
West Midlands SHA
East of England SHA
London SHA
South East Coast
South Central
South West SHA
p
(thousands) per 100,000
population
Total
Orlistat
1,109
1,087
2.12
2.08
71
195
136
100
126
104
161
77
52
87
70
191
133
98
123
101
158
76
50
85
2.73
2.81
2.56
2.23
2.30
1.78
2.05
1.76
1.25
1.64
2.69
2.75
2.51
2.19
2.26
1.73
2.02
1.72
1.22
1.61
1. Prescriptions are written on a prescription form known as a FP10. Each single item written on the form
is counted as a prescription item.
2. This information was obtained from the Prescribing Analysis and Cost Tool (PACT) system, which
covers prescriptions prescribed by GPs, nurses, pharmacists and others in England and dispensed in the
community in the UK. Prescriptions written in hospitals /clinics that are dispensed in the community,
prescriptions dispensed in hospitals, dental prescribing and private prescriptions are not included in PACT
data.
3. For data at Strategic Health Authority (SHA) level, prescriptions written by a prescriber located in a
particular SHA but dispensed outside that SHA will be included in the SHA in which the prescriber is
based.
4. Prescriptions written in England but dispensed outside England are included.
5. Office for National Statistics (ONS) estimated resident population mid-2010 figures have been used to
calculate prescription items per 100,000 population. Information on ONS population data is available at:
http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-213645
6. The 'Total' column includes Sibutramine which is not shown separately due to limited data for 2010 and
may not equal the sum of the individual drugs due to rounding.
7. The England figures include an unidentified Doctors element (where it is not possible for the
Prescription Pricing Division of the Business Service Authority to allocate to a SHA).
8. On 21st January 2010, the European Medicines Agency (EMA) released a statement advising the
suspension of sibutramine following a study which showed that there was an increased risk of non-fatal
heart attacks and strokes outweighing the benefits of this weight loss drug. Therefore, data on Sibutramine
will be limited for 2010.
Source:
Prescribing Analyses and Cost (PACT) from the Prescription Pricing Division of the NHS Business
Services Authority (PPD of the NHS BSA). The NHS Information Centre.
Copyright © 2012, re-used with the permission of the Prescription Pricing Division.
Copyright © 2012. The Health and Social Care Information Centre, Lifestyles Statistics. All rights reserved.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved
75
Appendix A: Key sources
Active People Survey
Allied Dunbar National Fitness Survey
Foresight Tackling Obesities: Future Choices – Project report
Health Survey for England
Hospital Episode Statistics
Living Costs and Food Survey
Low Income Diet and Nutrition Survey
National Diet and Nutrition Survey
National Travel Survey
Organisation for Economic Co-operation and Development (OECD) Health Data 2009
Prescription Pricing Division
Quality Outcomes Framework
School Meals Research Project
School Sport Survey
PE and Sport Survey
Tackling obesity in England
Taking Part Survey
Active People Survey
The Active People Survey (APS) is the largest ever survey of sport and active recreation to be
undertaken in Europe. It is a telephone survey of England (aged 16 and over) and provides statistics
on participation in sport and active recreation for all 354 Local Authorities (LA) in England (a
minimum of 1,000 interviews were completed in every LA in England). The APS, conducted by Ipsos
MORI on behalf of Sport England, started on the 15th October 2005 and was completed on 16th
October 2006. The sample was evenly divided over each month and spread across the whole year
for each LA to ensure the results are not biased by variations associated with different seasons.
Due to the success of the Active People Survey 2005/06, Sport England repeated the survey and
plan to run it as a continuous survey. The latest APS started in the middle of October 2009 and ran
for twelve months until mid October 2010. Headline results were published in December 2010.
The primary objective of the APS is to measure levels of participation in sport and active recreation
and its contribution to improving the health of the nation. Sport and active recreation includes walking
and cycling for recreation in addition to more traditional formal and informal sports. When measuring
sports participation the survey were concerned with not only the type of activity but also the
frequency, intensity and duration.
Data from the APS is described in Chapter 4 (Physical activity among adults).
The latest report, Active People Survey 2010/11 Headline results. Available at:
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 76
http://www.sportengland.org/research/active_people_survey/aps5.aspx
Allied Dunbar National Fitness Survey
The survey was designed to measure the activity and fitness levels of the adult population (aged 16
and over) in England. A representative sample of 6,000 adults was selected at random throughout
the country. The fieldwork was carried out between February and November 1990. A total of 4,316
people completed the home interview stage - a response rate of 75%. Seventy per cent of those
interviewed took part in a physical appraisal with 62% attending for tests at a specially equipped
mobile laboratory and 8%, primarily the elderly and infirm, being tested on a recurred set of
measurements in their homes.
Many aspects of behaviour, attitudes and beliefs were measured in the home interview. These
included:
•
•
•
•
•
•
•
Levels of participation in sport and active recreation, current and past, including access to
facilities and barriers to participation;
Physical activity at work, in housework, DIY and gardening and in moving about, that is walking,
cycling and stair-climbing;
Other lifestyle and health-related behaviour, including smoking, alcohol and dietary habits;
Current health status and history of illness;
Sports-related injuries;
Knowledge about exercise and attitudes towards physical activity, fitness and health;
Psychological variables including well-being, social support, stress and anxiety.
Information on the Allied Dunbar National Fitness Survey can be found in Chapter 4 (Physical activity
among adults).
Allied Dunbar National Fitness Survey. Available at:
http://www.esds.ac.uk/findingData/snDescription.asp?sn=3303
Foresight Tackling Obesities: Future Choices – Project report
One of the Foresight programmes based in the Government Office for Science. The report considers
how society might deliver a sustainable response to obesity in the UK over the next 40 years. One
objective of the project was to analyse how future levels of obesity might change and to identify the
most effective future responses. The report presents key messages and implications for the UK.
These are based on an extensive analysis of a wide range of evidence, including several
commissioned evidence reviews, a systems analysis of the primary determinants of obesity,
scenarios of possible futures and a quantitative model of future trends in obesity and associated
diseases.
To achieve this aim Foresight commissioned a model which utilises the dataset of the Health Survey
for England from 1994 to 2004 and employs extrapolation and microsimulation techniques to predict
the distribution of people across various BMI categories, to 2050. The report also models current and
future costs of obesity and obesity related diseases to the NHS. Foresight used the 2002 Health
Select Committee’s findings and uses £1 billion as the baseline for obesity attributable healthcare
costs in the modeling exercise. The model used forecasted costs solely on the basis of anticipated
additional morbidity arising from the increasing prevalence of obesity. Factors other than BMI,
including costs of disease were fixed at current levels.
77 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Data used from this report are presented in Chapters 2 and 3 (Obesity among adults and children).
Tackling Obesities: Future Choices 2nd Edition – Modelling Future Trends in Obesity and Their
Impact on Health. Foresight, Government Office for Science, 2007. Available at:
http://www.bis.gov.uk/assets/bispartners/foresight/docs/obesity/17.pdf
Health Survey for England
The Health Survey for England (HSE) is an annual survey, monitoring the health of the population
which is currently commissioned by The NHS Information Centre (the NHS IC), and before April 2005
was commissioned by the Department of Health. The HSE has been designed and carried out since
1994 by the Joint Health Surveys Unit of the National Centre for Social Research (NatCen) and the
Department of Epidemiology and Public Health at the Royal Free and University College Medical
School (UCL). All surveys have covered the adult population aged 16 and over living in private
households in England. Since 1995, the surveys have also covered children aged two to 15 living in
households selected for the survey, and since 2001 infants aged under two have been included as
well as older children. Trend tables are also published each year updating key trends on a number of
health areas.
Each survey in the series includes core questions and measurements such as blood pressure,
anthropometric measurements and analysis of saliva and urine samples, as well as modules of
questions on specific issues that vary from year to year. In recent years, the core sample has also
been augmented by an additional boosted sample from a specific population subgroup, such as
minority ethnic groups, older people or, as in 2006, 2007 and 2008, children.
This statistical report mainly uses data from HSE 2008, except for where updates to data are
available in the 2010 report. The primary focus of the HSE 2008 report was physical activity and
fitness. The report investigated associated lifestyle factors such as diet, smoking and drinking, and
also assessed the immediate impact of the smoking ban in public places introduced in England in
July 2007 as a secondary focus.
In 1999, the survey concentrated on the health of adults in six minority ethnic groups: Black
Caribbean, Indian, Pakistani, Bangladeshi, Chinese and Irish. In 2004, the survey once again
investigated the health of minority ethnic groups; the category of Black African was added to the six
groups in the 1999 survey. Some information from the HSE 04 is included in Chapter 2 (Obesity
among adults).
This report contains data and information from different HSE years. This is to provide the most
current information for the general population that was available at the time of publishing. Where
possible, data has been used from the HSE 2010, however there are some restrictions to this. For
further details of the HSE data used please see Appendix B (Technical notes).
Non-response weighting was introduced to the HSE in 2003, and has been used in all subsequent
years. Both weighted and unweighted bases are given in each table. The unweighted bases show
the number of participants involved. The weighted bases show the relative sizes of the various
sample elements after weighting, reflecting their proportions in the English population, so that data
from different columns can be combined in their correct proportions. The absolute size of the
weighted bases has no particular significance, since they have been scaled to the achieved sample
size.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 78
Since 1995, children’s data each year have been weighted to adjust for the probability of selection,
since a maximum of two children are selected in each household. This ensures that children from
larger households are not under-represented. Since 2003, non-response weighting has also been
applied in addition to selection weighting.
Trend tables in this publication present figures from 2003 onwards (the first year where non-response
weighting was applied) with and without non-response weighting. Data are shown in two rows or
columns, one showing unweighted results and the other weighted results. For tables showing trends
in children’s data, results for years up to 2002 are based on selection weighting only, and results for
2003 to 2006 are based on selection and non-response weighting. A full discussion of the effects of
non-response weighting can be found in the 2003 HSE report, Volume 3, Methodology and
Documentation. In the commentary in this report, where comparisons are made between 2008
figures and earlier years, weighted figures for 2008 are referred to since these are considered the
most accurate estimate of prevalence. As weighted figures are not available for years before 2003, it
is not possible to use weighted figures for earlier years and so the comparison is made with
unweighted figures.
Data from the HSE are used in Chapters 2, 3, 4, 5, 6 and 7.
The Health Survey for England 2008: Physical Activity and Fitness. Available at:
Main report:
www.ic.nhs.uk/pubs/hse08physicalactivity
Trend tables:
www.ic.nhs.uk/pubs/hse08trends
Health Survey for England – 2010: Respiratory Health. Available at:
Main report:
www.ic.nhs.uk/pubs/hse10report
Trend tables:
www.ic.nhs.uk/pubs/hse10trends
The Health Survey for England is a National Statistic.
Hospital Episode Statistics
NHS hospital Finished Admission Episodes (FAEs) in England have been recorded using Hospital
Episode Statistics (HES) since April 1987. HES aims to collect a detailed record for each 'episode' of
admitted patient care delivered in England by NHS hospitals or delivered in the independent sector
but commissioned by the NHS. HES data is presented in financial years, from April to March.
A Finished Admission Episodes (FAE) is the first period of in-patient care under one consultant within
one healthcare provider. The figures do not represent the number of in-patients, as a person may
have more than one admission within the year.
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Data from HES used in the report show Finished Admission Episodes with a primary diagnosis or
secondary diagnosis of obesity. Within HES, diagnoses are recorded using International
Classification of Diseases (ICD) codes. From the financial year beginning April 1995 onwards these
were classified using the tenth revision of ICD (ICD-10). Details of ICD-10 codes used are included
in Tables 7.6 to 7.13. The primary diagnosis is defined as the main condition treated or investigated
during the relevant episode of healthcare.
HES data used in Table 7.12 and 7.13 show the number of Finished Consultant Episodes (FCEs) for
“bariatric surgery”. The term “bariatric surgery” is often used to define a group of procedures that can
be performed to facilitate weight loss although these procedures can be performed for conditions
other than weight loss. It includes stomach stapling, gastric bypasses and sleeve gastrectomy. An
FCE is a period of care under one consultant and patients may experience more than one FCE in a
single hospital admission. The figures do not represent the number of patients, as a person may
have more than one episode of care within the year or more than one episode of care within a visit to
hospital. Bariatric surgery procedures identified using a primary diagnosis of obesity and a main or
secondary procedure code for bariatric surgery. Within HES, procedures and interventions are
recorded using the Office of Population, Censuses and Surveys: Classification of Interventions and
Procedures, 4th Revision (OPCS-4) codes. OPCS-4.2 were used to identify bariatric surgery
procedure codes between the years 1996/97 to 2005/06 and OPCS-4.3 codes were used for
2006/07, OPCS-4.4 codes were used for 2007/08 and 2008/09, OPCS-4.5 codes were used for
2009/10 and OPCS-4.6 codes were used for 2010/11, however there were no changes to the codes
used to define bariatric surgery between OPCS-4.3 and OPCS-4.4. Details of the OPCS-4.6 codes
used are included in Appendix B. The main procedure is usually the most resource intensive
procedure performed during the episode.
HES data are shown in Chapter 7 (Health outcomes).
Living Costs and Food Survey (LCF), formerly Expenditure and
Food Survey (EFS)
The LCF collects information on the type and quantity of food and drink purchased in households.
The LCF was previously known as the Expenditure and Food Survey (EFS). It was renamed in 2008
when it became a module of the Integrated Household Survey (IHS).
The Expenditure and Food Survey (EFS) was created in 2001 to replace the National Food Survey
(NFS) and the Family Expenditure Survey (FES). The EFS provides data on spending and food
purchases since the 1950s. Each household member over the age of seven kept a diary of all their
expenditure and quantities of purchased food and drink over a two week period.
Historical estimates of household purchases between 1974 and 2000 have been adjusted to align
with the level of estimates from the FES in 2000. Whilst estimates of household consumption from
the NFS have been adjusted, a break in the series between 2000 and 2001 remains and should be
borne in mind when interpreting reported changes before and after this period.
The aligned estimates are generally higher than the original ones and indicate that the scaling has
partially corrected for under-reporting in the NFS. Under-reporting may be lower in the EFS because
it does not focus on consumption but on expenditure across the board and is largely based on till
receipts.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 80
Reliable estimates on food and drink eaten out from the EFS start in 2001/02, less reliable estimates
are available from the NFS going back to 1994.
LFC is the data source for two publications, Family Food, published by the Department for
Environment, Food and Rural Affairs and Family Spending, published by the Office for National
Statistics.
Chapter 6 (Diet) of this report presents data published in Family Food using the LFC. Throughout the
chapter figures used prior to 2001/02 are adjusted NFS estimates. The adjustments brought the
results of the NFS into line with the EFS, and tended to increase estimates of food and drink
purchases. The largest adjustments were for confectionery, alcoholic drinks, beverages and sugar
and preserves. Adjustments for eggs and carcase meat resulted in reduced NFS estimates. Details
of the adjustments to the NFS estimates can be found in Family Food 2002/03.
In 2005/06 significant revisions were made affecting estimates from 2001/02 to 2004/05. The
revisions introduce estimates of free food into both eating out and household food and quantity and
nutrient content for a range of unspecified food purchases which are estimated based on averages of
other food purchases recorded in the survey. Examples of free food estimates now included in the
survey are meals on wheels, free welfare milk in the home, free milk, fruit and vegetables provided by
schools, free meals provided by schools and employers, food purchased for business that is paid for
by employer and buffet meals where items are not specified (such as Indian, Chinese, salad bar etc).
In 2006 the survey moved from a financial year to a calendar year basis in preparation for its
integration to the Integrated Household Survey in January 2008. As a consequence there is an
overlap of results, data collected between January 2006 and March 2006 are included in the 2005/06
results and the 2006 results. Where the report looks at 3 year averages and 4 year trends this
duplication of data has been removed.
As this survey collects information on purchases, consumption is approximated using a wastage
estimate. Purchases may differ from actual food consumption for a number of reasons e.g. food may
be discarded during preparation, food maybe left on the plate at the end of a meal or food may
become inedible before it can be consumed and is thrown away. When average intakes are
compared with reference nutrient intakes, a figure of 10% is used for wastage on all types of food
and drink. Trends in energy and nutrient content of the purchases are based on a database of
nutrient profiles for different types of food which are kept up to date by the Food Standards Agency.
Data from the latest Family Food and LCF can be found in Chapter 6 (Diet).
Expenditure and Food Survey. Available at
http://www.esds.ac.uk/government/efs/
Family Food 2010, Department for Environment, Food and Rural Affairs, 2011. Available at:
http://www.defra.gov.uk/statistics/foodfarm/food/familyfood/
Family Spending. Available at:
http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=361
81 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Low Income Diet and Nutrition Survey
As the National Diet and Nutrition Survey (also described in this appendix) provided evidence to
suggest that differences in food consumption exist between lower and higher socioeconomic groups,
the Low Income Diet and Nutrition Survey (LIDNS) was conducted between 2003 and 2005 focusing
specifically on people from the low income population in the United Kingdom. This survey provides a
comprehensive picture of food consumption and nutritional status of a nationally representative
sample living in low income and materially deprived households. It also assessed numerous socioeconomic, environmental, behavioural and attitudinal factors, and lifestyle and health characteristics
which relate to food consumption, nutritional status and nutrition-related health. The purpose of the
survey was to provide an evidence base that would contribute to the development of food policy,
which in turn would help to reduce health inequalities.
Screening questionnaire
A score-based screening questionnaire was devised specifically for LIDNS to provide a useful and
discriminating measure of low income and material deprivation. This included a series of questions
on use of cars/vans, receipt of incapacity benefit, income support or job seekers allowance, housing
and council tax benefits and then further questions on weekly net income for those who have a
borderline score.
Dietary Interview
From all households that were screened in as eligible for the survey, two respondents were randomly
selected to take part, either one adult (aged 19 and over) and one child (aged 2-18) or two adults (in
households with no children). Both respondents as well as the household’s main food provider (if
they were not one of the selected respondents) had an extensive face-to-face computer assisted
personal interview. Information about the 24 hour dietary recall process was then given and the first
24h recall was completed.
Repeat 24 hour dietary recall
An interviewer visited the household on a total of four randomly selected non-consecutive days
(including where possible a weekend day) over a ten day period to conduct the 24 hour dietary recall
interviews. The 24 hour recall method used was the ‘triple pass’ method, which gives respondents
three opportunities to think through what they ate and drank over the previous 24 hour period.
Respondent’s height and weight measurements were recorded during the second visit.
Nurse visit
All individuals completing three or four dietary recalls were eligible for the second part of the survey,
which consisted of a visit from a qualified nurse. The nurse collected details of any prescribed
medications and non-prescribed dietary supplements and took further measurements, including
blood pressure, waist and hip measurements and where consented to, a blood sample.
Data from the LIDNS can be found in Chapter 6 (Diet)
The latest Low Income Diet and Nutrition Survey. Available at:
http://www.food.gov.uk/science/dietarysurveys/lidnsbranch/
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 82
National Diet and Nutrition Survey (NDNS)
The National Diet and Nutrition Survey (NDNS) programme aims to provide a comprehensive picture
of the dietary habits and nutritional status of the population of the Britain. In its original form the
NDNS was a series of cross-sectional surveys covering the whole population from age 1½ years
upwards, split into four different population age groups: children aged 1½ to 4½ years (fieldwork
1992/93), young people aged 4 to 18 years (1997), adults aged 19 to 64 years (2000/01) and people
65 years and over (1994/95).
Following a review of the Food Standards Agency’s dietary survey programme in 2002/03 the NDNS
has now moved to a rolling programme in which the survey will run continuously with fieldwork every
year, (which started in 2008) covering a UK representative sample of both adults and children. This
will strengthen the ability to track changes over time and give flexibility to respond more rapidly to
changing data requirements
Data from the NDNS are essential for underpinning a wide range of the Food Standards Agency’s
work to protect consumer safety and promote healthy diets. The survey provides detailed data on
foods consumed by individuals and nutrient intakes with additional information on nutritional status
(derived from analysis of blood samples), physical measurements and lifestyle habits such as
smoking, drinking and physical activity.
The components of the survey
The survey includes various components (described below) in order to obtain the wide range of
information required. Respondents may choose to participate in some components but not in others.
The components of the most recent NDNS of adults aged 19-64 years are described below.
Dietary interview
Initially a face-to-face dietary interview was carried out with the household member selected to take
part in the survey (the respondent), to provide information about their eating and drinking habits, their
socio-demographic circumstances (e.g. age and marital status) and the socio-demographic
circumstances of their household (e.g. benefit status).
Seven-day weighed intake dietary record
Respondents were also invited to complete a dietary record for seven days. This involved weighing
and recording all food and drink consumed both at home and away from home, including medicines
taken by mouth and drinks of water. The dietary record collected detailed information in order to look
at the range of food consumption and nutrient intake within the population. Food and nutrient intake
data could also be related to physical activity and various nutritional status and health measures.
Other components
These included a 24-hour urine collection (used to estimate salt intake); physical measurements
(BMI, blood pressure and waist and hip circumferences); a seven-day physical activity record (to
allow an investigation of the relationships between dietary intakes, body composition and physical
activity levels); and a blood sample (which was analysed for a range of nutritional status indicators
which reflect the levels of certain nutrients available for use in the body).
83 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
The information from the dietary record was linked to a nutrient databank and nutrient intakes were
calculated from the quantities of foods consumed. No attempt has been made to adjust the nutrient
intakes presented here to take account of underreporting.
Data from the NDNS can be found in Chapter 6 (Diet).
National Diet Nutrition Survey: headline results from years 1 and 2 (2008/2009 – 2009/2010),
Department of Health. 2011. Available at:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_128166
The National Diet and Nutrition Survey, available at:
http://www.food.gov.uk/science/dietarysurveys/ndnsdocuments/
Issues associated with reporting food consumption in dietary
surveys
Mis-reporting of food consumption in dietary surveys, generally under-reporting, is known to be a
problem in dietary surveys worldwide. Under-reporting can cause biased low estimates of intake as
respondents under-report their actual intake or modify their diet during the recording period. The level
of under-reporting needs to be borne in mind when interpreting findings from dietary surveys, for
example in comparing intakes with recommendations. Analysis of data from the NDNS adults
2000/01 indicated that energy intake could be under-reported by about 25%. It is not possible to
ascertain whether under-reporting was higher in this survey than in the 1986/87 survey because
there was no assessment of physical activity or energy expenditure in the earlier survey. Doubly
labelled water studies suggest similar levels of under-reporting for other age groups except for preschool children where levels were lower. There is evidence that under-reporting is selective – fatty,
sugary and snack foods and alcohol are more likely to be under-reported than are other foods such
as fruit and vegetables. However the level of under-reporting for specific macro and micronutrients is
not known.
The National Diet and Nutrition Survey is an official statistic.
National Travel Survey
The National Travel Survey (NTS) is a survey on personal travel. It provides the Department for
Transport, Local Government and the Regions (DTLR) with data to answer a variety of policy and
transport research questions. The 2010 NTS is the latest in a series of household surveys designed
to provide a databank of personal travel information for Great Britain. It is part of a continuous survey
that began in July 1988, following ad hoc surveys since the mid-1960s. The survey is designed to
identify long-term trends and is not suitable for monitoring short-term trends.
NTS respondents keep a travel diary of their trips within Great Britain over a seven day period. Travel
details provided by respondents include trip purpose, method of travel, time of day and trip length.
The households also provided personal information, such as their age, gender, working status and
driving licence holding, and details of the cars available for their use. In order to minimise the burden
of completing the diaries respondents include walks of under one mile on the seventh day only, but
all tables in this publication include data on short walks (over 50 yards) grossed up for the full seven
day period.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 84
Data from NTS are used in Chapter 4 and 5 (Physical activity among adults and children).
The National Travel Survey 2010. The Department for Transport, 2011. Available at:
http://assets.dft.gov.uk/statistics/releases/national-travel-survey-2010/nts2010-01.pdf
This is a National Statistic.
Organisation for Economic Co-operation and Development
(OECD) Health Data 2011 – Frequently Requested Data
Released during November 2011, this report offers the most comprehensive source of comparable
statistics on health and health systems across OECD countries. It is an essential tool for health
researchers and policy advisors in governments, the private sector and the academic community, to
carry out comparative analyses and draw lessons from international comparisons of diverse health
care systems.
Data from this report can be found in Chapter 2 (Obesity among adults).
Health at a Glance 2011. Organisation for Economic Co-operation and Development, 2011. Available
at:
http://www.oecd.org/dataoecd/6/28/49105858.pdf
Definitions. Sources and Methods can be found at:
http://www.oecd.org/document/30/0,3746,en_2649_33929_12968734_1_1_1_1,00.html
Prescription Pricing Division
Prescription statistics in this report are for calendar years. All prescription statistics in this report are
based on information systems at the NHS Business Services Authority Prescription Pricing Division
(NHSBSA (PPD)). The system used is the Prescription Analysis and Cost Tool (PACT). This system
is based on an analysis of all prescriptions dispensed in the community, i.e. by community
pharmacists and appliance contractors, dispensing doctors, and prescriptions submitted by doctors
for items personally administered.
Each item written on the prescription form (FP10) is counted a single prescription item regardless of
the quantity prescribed. Therefore differences in prescribing practices between GPs are not reflected
in this data. The counts include items that are prescribed by GPs, nurses, pharmacists and others in
England and then subsequently dispensed in the community. Therefore prescriptions that are written
but not actually dispensed to the patient (or their representative) are not counted. Prescriptions
written in hospitals or clinics that are dispensed in the community, prescriptions dispensed in
hospitals, dental prescribing and private prescriptions are also not included.
Data from the Prescription Pricing Division can be found in Chapter 7 (Health outcomes).
85 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Quality and Outcomes Framework
The Quality and Outcomes Framework (QOF) was introduced as part of the new General Medical
Services (GMS) contract on 1 April 2004. It is a voluntary annual reward and incentive programme for
all GP surgeries in England, detailing practice achievement results. The QOF contains four main
components, known as domains. Each domain consists of a set of measures of achievement, known
as indicators, against which practices score points according to their level of achievement
QOF is measured by QMAS, a national IT system developed by NHS Connecting for Health (CfH). It
is not a comprehensive source of data on quality of care in general practice, but it is potentially a rich
and valuable source of such information, providing the limitations of the data are acknowledged. The
Prescribing Support Unit (PSU), part of The NHS Information Centre, works on behalf of the
Department of Health and in collaboration with CfH to obtain extracts from QMAS to support the
publication of QOF information.
QMAS captures the number of patients on the clinical register for each practice. The number of
patients on the clinical registers can be used to calculate measures of disease prevalence expressing
the number of patients on each register as a percentage of the number of patients on each practice
lists.
Data from the QMAS database can be found in Chapter 2 (Obesity among adults).
Quality and Outcomes Framework Information. Available at:
http://www.ic.nhs.uk/statistics-and-data-collections/audits-and-performance/the-quality-andoutcomes-framework
This is an official statistic.
School Meals Research Project
In 2001 National Nutritional Standards were reintroduced to set out the frequency with which school
caterers must provide items from the main food groups. The Department for Education and Skills
(DfES) and the Food Standards Agency (FSA) commissioned a survey in 2003 to assess compliance
with the standards and to measure food consumption in school among secondary school pupils. The
survey was conducted in a nationally representative sample of 79 secondary schools across England
providing information about catering practise and food provisions at lunchtime and information about
the food selections and nutrient intake of 5,695 secondary school pupils aged 11 to 18.
This document is referred to in Chapter 6 on Diet.
School Meals in Secondary Schools in England. Available at:
http://www.food.gov.uk/science/dietarysurveys/primaryschoolmeals
School Sport Survey
The Department for Education (DfE, formerly Department for Children, Schools and Families
(DCSF)) commissioned Target Nutrient Specifications (TNS), an independent research company, to
conduct the fifth and final annual survey of school sport in England covering the academic year
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 86
2007/08. The survey aimed to collect information about levels of participation in physical education
(PE) and school sport in partnership schools. In total, 21,631 schools within school sport partnerships
took part in the survey between May 2008 and July 2008. The 2007/08 survey reported on what over
6 million school children are doing in terms of physical activity. The survey is the largest of its kind in
Europe.
School sports partnerships bring primary, special and secondary schools together in a network
benefiting from extra staff and funding to increase sports opportunities for pupils. At the time of the
2007/08 survey 90% of pupils in schools within the School Sport Partnership programme participated
in at least two hours of high quality PE and out of hours school sport in a typical week. This compared
to 86% in 2006/07, 80% in 2005/06, 62% in 2003/04 and the estimated position of 25% in 2002.
The 2007/08 School Sport Survey. Available at:
http://publications.dcsf.gov.uk/default.aspx?PageFunction=productdetails&PageMode=publications&
ProductId=DCSF-RW063&
PE and Sport Survey
In 2008/09 TNS-BMRB (formerly TNS), an independent research company, was commissioned to
conduct a further survey of school sport and to provide a consistent dataset to help understand
further progress that has been made within partnership schools. The latest 2009/10 survey has
continued in its aims to collect information from all partnership schools in the mainstream sector in
England and from all Further Education (FE) colleges. Information was collected on the proportion of
pupils receiving 2 hours of curriculum PE and the proportion of pupils participating in at least 3 hours
of PE and school sport.
Data from the School Sport Survey can be found in Chapter 5 (Physical activity among children).
The PE and School Sport Survey 2009/10 is available at:
http://www.education.gov.uk/publications/RSG/publicationDetail/Page1/DFE-RR032
This is an official statistic.
Tackling obesity in England
In 2001, the National Audit Office (NAO) produced this report which among other subjects, estimated
the cost of treating obesity. Costs of obesity were estimated by taking a prevalence-based, cost of
illness approach based on extensive literature review and using published data. The cost of treating
obesity covers the costs of GP consultations related to obesity, hospital admissions and outpatient
attendances and drugs prescribed to help obese patients lose weight. The most recent published
data on incidence of these events in England was multiplied by unit costs to calculate a total cost.
Prescription costs for obesity were taken from Prescription Cost Analyses reports for England.
The cost of treating the consequences of obesity covered the cost of treating diseases such as
coronary heart disease which can be directly attributed to obesity. The cost of treating these diseases
was estimated by calculating the relevant population risk proportion. A systematic review of literature
was undertaken to establish for each disease, the best data available on the proportion of that
87 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
disease in the population that was attributable to obesity. This proportion was defined by the relative
risk of developing the associated diseases for individuals with obesity compared to the risk for nonobese individuals.
To establish the cost of treating associated diseases in 1998, data on GP consultation rates, hospital
inpatient admissions and hospital outpatient attendances were obtained. These were multiplied by
unit costs to derive an estimate of the NHS treatment costs for each disease. Prescription costs were
taken from Prescription Cost Analyses reports for England. These cost estimates were then applied
to the data on relative risk and age and sex specific prevalence of obesity from the HSE to give an
estimate of the cost of treating the consequences of obesity.
It is recognised that the direct costs of treating obesity, estimated as £9.5 million in 1998 is probably
an under-estimate because the main component of this cost, GP consultations, was based on data
from 1991-92 since which obesity prevalence has increased, and no data were available for
consultations with practice nurses and dieticians in primary care.
Also, the cost of treating the consequences of obesity is likely to be under-estimated. There are a
number of potentially important diseases that were excluded from the analyses because of the lack of
data to allow an estimate of the proportion of treatment costs that could be attributed to obesity, for
example, depression, hyper-lipidemia and back pain, because no studies were identified in the
review that reported the relative risk for obese individuals of developing these conditions. Other
limitations of the study are the differing definition of obesity in some of the studies (although no bias
was determined), the application of the international studies to the UK population and the cost to
other public organisations is not covered e.g. costs to social services.
Tackling Obesity in England. Available at:
www.nao.org.uk/publications/0001/tackling_obesity_in_england.aspx
Taking Part Survey
The Taking Part Survey (TPS) was commissioned by the Department for Culture, Media and Sport
(DCMS) working in partnership with several of its non-departmental public bodies. The survey
collects data about engagement and non-engagement in culture, leisure and sport. This information
helps the DCMS and its partner bodies to better understand those who do, and do not, engage with
its sectors.
The DCMS’ current Public Service Agreements (PSAs) have a significant focus on increasing
participation in Arts, Sport, Museums and Heritage, particularly by a range of ‘priority groups’. The
TPS has now become the mechanism for monitoring progress against several of these targets.
Since mid-July 2005, BMRB Social Research (now integrated with TNS Social Research) has been
conducting continuous face to face interviews with adults aged 16 or over living in private households
in England
From January 2006, children aged 11-15 were included within the survey and in 2008/09, children
aged 5-15 were surveyed.
Data from the Taking Part Survey are used in Chapters 4 and 5 (Physical activity among adults and
children).
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 88
The Taking Part 2010/11 Adult and Child Report, Statistical Release. Available at:
Main Report:
http://www.culture.gov.uk/images/research/taking-part-Y6-child-adult-report.pdf
Headline figures from the 2009/10 Taking Part Adult and Child Report:
http://www.culture.gov.uk/publications/7386.aspx
This is a National Statistic.
Other related information:
Taking Part: The National Survey of Culture, Leisure and Sport – Final assessment of progress on
PSA3: complete estimates from year three, 2007/08. Available at:
http://www.culture.gov.uk/reference_library/publications/5653.aspx
2007 Comprehensive Spending Review (PSA21 : indicator 6).
http://www.hm-treasury.gov.uk/pbr_csr07_psacommunities.htm
89 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Appendix B: Technical notes
Overweight and obesity
Adults BMI
Children - UK National BMI percentile classification
Children - International Obesity Task Force (IOTF)
NICE guidance
Physical activity among adults
Activity types, frequency, duration, and intensity
Objective measures of physical activity - Accelerometry
Objective measures of physical activity - Summary activity levels
Objective measures of physical activity - Fitness
English, Scottish and Welsh comparisons among adults
Physical activity among children
Summary activity levels
Active sport
Diet and nutrition
Fruit and vegetable portions
Estimated Average Requirements and Reference Nutrient Intakes
Health Survey for England
Age standardisation
Use of HSE data from different years
General Health Questionnaire GHQ12
Blood pressure
Weighted HSE data used in Chapter 7: Health Outcomes
Equivalised household income quintiles
Logistic regression
Hospital Episode Statistics: coding for bariatric surgery
Overweight and obesity
Adults BMI
Overweight and obesity among adults is measured in the Health Survey for England (HSE) using
Body Mass Index (BMI). The BMI is calculated by dividing weight in kilograms, by the square of the
height in metres (kg/m2).
BMI =
Weight (kg )
Height 2 (m 2 )
Adults are classified into the following BMI groups:
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 90
BMI range (kg/m2)
Under 18.5
18.5 to less than 25
25 to less than 30
Definition
Underweight
Normal
Overweight
30 and over
Obese
40 and over
Morbidly obese
25 and over
Overweight including obese
Children
British 1990 growth reference percentiles
Due to differences in growth rates among boys and girls at each age, it is not possible to apply a
universal formula in calculating obesity and overweight prevalence in children. Each sex and age
group therefore needs its own level of classification for obesity. The British 1990 growth reference
(UK90) percentiles is therefore used which gives a BMI threshold for each age above which a child is
considered overweight or obese; those children whose BMI is above the 85th percentile are classified
as overweight and those children whose BMI is above the 95th percentile are classified as obese.
The percentiles are given for each sex and age. According to this method, 15% and 5% of children in
1990 had a BMI above this level and were thus classified as overweight/obese. Increases over 15%
and 5% in the proportion of children who exceed the reference 85th/95th percentiles over time
indicate an upward trend in the prevalence of overweight and obesity. Unless otherwise specified
figures relating to the prevalence of childhood obesity in this report are determined by this method.
International Obesity Task Force (IOTF)
This is an alternative method of determining childhood obesity. It is based on BMI reference data
from six different countries around the world (over 190,000 subjects in total aged 0 to 25 from UK,
Brazil, Hong Kong, the Netherlands, Singapore, and the United States). The BMI percentile curves
that pass through the values of 25kg/m2 and 30 kg/m2 (standard cut-off points for overweight and
obesity, respectively) at age 18 were smoothed for each national dataset and then averaged. The
averaged curves were then used to provide age and sex-specific BMI cut-off points for children and
adolescents aged 2 to 18. The benefit of this approach is that it allows international comparisons of
levels of obesity in children to be made. Figures derived using this method are discussed in Chapter
3 (Obesity among children) of this bulletin commenting upon results from Foresight: Tackling
Obesities: Future Choices. For further information this report is available at:
http://www.foresight.gov.uk/OurWork/ActiveProjects/Obesity/KeyInfo/Index.asp
National Institute for Health and Clinical Excellence (NICE) guidance
NICE guidance suggests that the measurement of waist circumference should be used for people
with a BMI less than 35kg/m2 to assess health risks (as shown in the table below). For adults with a
BMI of 35kg/m2 or more, risks are assumed to be very high with any waist circumference.
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Assessing risk from overweight and obesity
BMI classification
Waist circumference
Low
High
Very high
Normal weight
No increased risk
No increased risk
Increased risk
Overweight (25 to less than 30 kg/m2)
No increased risk
Increased risk
High risk
Obesity I (30 to less than 35 kg/m2)
Increased risk
High risk
Very high risk
For men, low waist circumference is defined as less than 94 cm, high as 94–102 cm, and very high as greater than 102 cm.
For women, low waist circumference is less than 80 cm, high is 80–88 cm and very high as greater than 88 cm.
Source:
National Institute for Health and Clinical Excellence (NICE) guidelines
Further information on the NICE guidelines is available at: http://www.nice.org.uk/guidance/CG43
Physical activity and fitness among adults
The Health Survey for England (HSE) 2008 presented information on physical activity and fitness.
Information on Adults’ self-reported physical activity in the last four weeks was collected using an
enhanced version of the HSE physical activity questionnaire, developed and tested in 2007. The
physical activity module was first used in the HSE in 1991,repeated in 1992 to 1994 with minor
changes, and received more substantial revisions in 1997 and 1998 (producing what is generally
referred to as the ‘long’ version of the questionnaire). A ‘shorter’ version of the questionnaire was
introduced in 1999, when the focus was minority ethnic groups; the shorter questionnaire was
repeated in 2002, 2003 and 2004. In 2006, a slightly modified version of the long (1998) form of the
questionnaire was used. In 2008, a new occupational physical activity set of questions were included
within the questionnaire and additional questions on sedentary behaviour were also asked. To enable
continuation of these trend data, the same methods for analysis were used in 2008, as well as the
more detailed definition possible for 2008 using the enhanced questionnaire.
Activity types, frequency, duration, and intensity
Details about four main types of physical activity were included in the questionnaire. For most
activities in which they had participated, respondents were asked on how many days in the last four
weeks they had done the activity for at least 10 minutes, and the average length of time spent on
those days.
1. Home activity consisted of housework and gardening/DIY/building that lasted 10 minutes or more.
The lead-in question was ‘Have you done any housework in the last four weeks?’ Participants were
shown a card with a list of examples of light housework and were asked if they had done any of the
listed activities. They were then asked about heavy housework by showing another card with higher
intensity activities, for which frequency was assessed. A similar sequence of questions was asked for
gardening/DIY/building work. Frequency of light home activity (i.e. those activities listed in the first set
of show cards) was not assessed.
2. Walks of 10 minutes or more. The key question was ‘During the past four weeks, on how many
days did you do a walk of least 10 minutes? ’Walking intensity was assessed by asking participants
to rate their usual walking pace (slow / average / fairly brisk / fast).
3. Sports and exercise activities that lasted 10 minutes or more. For sports and exercise activities in
the four weeks prior to interview, participants were asked ‘Can you tell me on how many separate
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 92
days did you do (name of specific sport and exercise activity) for at least 10 minutes at a time during
the past four weeks…?’, followed by a question about the activity’s usual duration on these days. The
intensity of these activities was assessed by asking participants whether or not the activity had made
them ‘out of breath or sweaty’.
4. Occupational activities that lasted 10 minutes or more. After establishing whether participants did
any paid or unpaid work in the last four weeks, the key question was ‘Which of these did you do
whilst working? Sitting down or standing up; walking at work; climbing stairs or ladders; lifting,
carrying or moving heavy loads’, followed by a question about the time spent on that type of activity
on these days. As in previous years, participants were also asked ‘Thinking about your job in general
would you say that you are…very physically active; fairly physically active; not very physically active;
not at all physically active?’
Objective measures of physical activity
Accelerometry
Accelerometers provide objective information on the frequency, intensity, and duration of both
physical activity and sedentary behaviour. Using an accelerometer to collect activity data has the
advantages of being objective and providing standardised measures, unlike self-report of activity.
Direct monitoring reduces recall bias and other problems of subjectivity.
Within the HSE 2008, a sub-sample of adults were asked to wear an accelerometer for the week
following the completion of the questionnaire. Participants wore the monitor during waking hours and
kept a record of activities when the monitor was not worn, for example while swimming.
Summary activity levels
The summary measure of physical activity levels groups informants in a way that allows comparisons
to the Chief Medical Officer (CMO) physical activity guidelines, which for adults are that they should
achieve a total of at least 30 minutes of at least moderate activity, either in one session or in multiple
bouts of at least 10 minutes duration, on five or more days of the week. The CMO also recommends
that at least twice a week this should include activities to improve bone health, muscle strength and
flexibility. Moderate intensity activities have an energy cost of at least 5 kcal/min but less than 7.5
kcal/min and include heavy housework or gardening and sports which make the individual breathe
heavily and become sweaty.
The summary activity level classification for both the self-reported and objective measures of physical
activity are as follows:
•
Meets recommendations: 20 or more occasions of moderate or vigorous activity of at least 30
minutes duration in the last four weeks (i.e. at least five occasions per week on average). This
category corresponds to the minimum activity level required to gain general health benefits (e.g.
reduction in the relative risk for cardiovascular morbidity). However, it does not necessarily
indicate the extent of activity required for optimal cardiovascular fitness or for optimal weight
control.
93 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
•
Some activity: Four to 19 occasions of moderate or vigorous activity of at least 30 minutes
duration in the last four weeks (i.e. at least one but fewer than five occasions per week on
average).
•
Low activity: Fewer than four occasions of moderate or vigorous activity of at least 30 minutes
duration in the last four weeks (i.e. less than once per week on average).
For comparisons of summary activity levels over time, HSE 2008 self-report data have been
analysed with the lower duration for activities set to 30 minutes, to be comparable with results
obtained from the shorter questionnaire used in 2003 and 2004. 1997 and 1998 data were also
reanalysed using this longer minimum duration, to enable data for the five years to be compared. In
2008 bouts of activity lasting at least 10 minutes counted towards meeting the recommendations.
Therefore, three bouts of activity lasting at least 10 minutes each would be considered sufficient to
meet the recommendations on that day. Because bouts of activity lasting a minimum of 30 minutes
are being used for comparison with results from previous years, the results presented in this chapter
are likely to be an underestimate of the proportion of the population that meets the revised
recommendations.
Fitness
Physical fitness, also called functional capacity, is the ability of an individual to perform work. The
most common form of work capacity assessed is the aerobic component, measured by the maximal
oxygen uptake (VO2max). Oxygen uptake refers to the use of oxygen by the body’s cells. Oxygen
uptake rises rapidly on starting exercise and reaches a plateau (steady state VO2) by three to five
minutes of steady exercise. Maximal oxygen uptake is reached when oxygen uptake does not
increase despite further increase in intensity of the exercise (e.g. running faster or up a steeper
incline), although not everyone has such a plateau. VO2max is typically achieved by exercise that
involves only about half the total body musculature.
In the HSE 2008, a sub-sample of adults aged 16 to 74 had their fitness levels assessed using a step
test. An indirect method of measuring physical fitness was chosen because of the survey design of
conducting the tests in participants’ homes; direct measurement of oxygen consumption was
therefore not possible. The decision to use a step test rather than a treadmill or cycle ergometer was
also made for practical reasons. A single step was chosen as this was easier for the nurses to
transport to participants’ homes than the double step that was piloted with considerable problems in
2005.
The physical fitness test consisted of the step test originally developed by researchers at Medical
Research Council (MRC) Cambridge. The test involved the subject stepping up and down a single
step. The pace was given digitally by the nurse’s laptop and the stepping lasted a maximum of eight
minutes. The pace of stepping increased through the duration of the test. The participant stepped up
and down first at a slow pace for one minute, at a rate of one leg movement per second. This
equates to one body lift (i.e. the respondent stepping up and back down from the step) over four
seconds. Then the stepping pace gradually increased over the next seven minutes until, by the end
of the eighth minute, the frequency was 33 body lifts per minute (i.e. one body lift in just under two
seconds).
The participant’s heart rate was the primary outcome measure of the step test. The heart rate was
recorded at 30 second intervals during the test and at 15 second intervals for two minutes after the
step test ended. The participant wore a Polar heart rate monitor round the chest which transmitted
the heart rate to a receiver worn on the participant’s wrist. Using a stop watch to mark the time
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 94
intervals, the nurse recorded the heart rate detected by the monitor. These heart rate measurements
were then combined with the resting heart rate obtained earlier during blood pressure measurement
to determine the submaximal relationship between heart rate and oxygen uptake. This relationship
was then extrapolated up to age-predicted maximal heart rate to provide an estimate of the
individual’s maximal oxygen uptake (VO2max), the overall level of fitness.
Fitness categories in the HSE 2008 were defined as follows:
•
Light exertion: requiring less than 30% of that person’s VO2max
•
Moderate exertion: requiring 30-64% of that person’s VO2max
•
Severe exertion: requiring 65-100% of that person’s VO2max (therefore unsustainable for any
substantial length of time)
•
Maximal exertion: requiring more than 100% of that person’s VO2max
English, Scottish and Welsh comparisons among adults
The Scottish Health Survey (SHS) 2008 physical activity module is based on the Allied Dunbar
National Fitness Survey (ADNFS). A very similar questionnaire was used in both the 1998 and 2003
SHS and therefore comparisons over time are uncomplicated. Participants were asked about there
participation in 4 types of activities:
•
•
•
•
Home-based activities (housework, gardening, building work and DIY);
Walking;
Sports and exercise;
Activity at work.
Prior to the SHS 2008, duration of participation in physical activities was set to 15 minutes. However,
as the CMO recommendations state that activity can be accumulated in bouts of 10 minutes the
questionnaire was updated in 2008 to include activities of 10 to 14 minutes duration.
The SHS 2008 also collected information on the amount of time that participants spent in sedentary
behaviours.
The Welsh Health Survey asked adults on which days in the past week they did at least 30 minutes
of light, moderate, and vigorous exercise or physical activity. In this survey blocks of activity lasting
more than 10 minutes, which were done on the same day, count towards the full 30 minutes.
Respondents were asked to include physical activity which is part of their job. Examples of each type
of activity are:
•
•
•
light activity - housework or golf
moderate activity - heavy gardening or fast walking
vigorous activity - running or aerobics.
Physical activity among children
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The Chief Medical Officer (CMO) of England recommends that children and young people should do
a minimum of 60 minutes of at least moderate intensity physical activity each day. Children should
also participate in activities that improve bone health, muscle strength and flexibility at least twice a
week.
In HSE 2008, the children’s physical activity questionnaire was completely revised. The key changes
to the 2008 questionnaire were:
•
A new division of sports and activities into formal and informal; and as well as the activities on the
show cards, participants were asked about any other similar activities they had done, and these
were recorded individually;
•
For each activity undertaken, participants were asked on which specific days of the week they
had done them, rather than on how many weekdays and weekend days;
•
For each day that the participant had done an activity, they were asked how long they had done it
(in hours and minutes), rather than giving an average for all the days using half hour bands.
Due to the significant revisions to the 2008 children’s physical activity questionnaire, the results
reported here are not directly comparable with previous HSE reports that present findings on child
physical activity.
The HSE 2008 self-report questionnaire collected details about the out-of-school activity of children
aged 2 to 15. The decision to exclude activities which are part of the school curriculum was taken for
three reasons. Firstly, it was assumed that, generally speaking, the amount of activity carried out by
children as part of school lessons would be similar for all children (according to their age) and would
contribute to a ‘standard’ additional amount of activity for each child. Secondly, activities as part of
the school curriculum would generally be compulsory and the survey was more concerned with what
children would do of their own choice. Thirdly, since a large proportion of data would be collected by
proxy from a parent, it was felt that information about activities during school lessons would be less
accurate than information about leisure time activities. However, any activities carried out on school
premises but not as part of school lessons (e.g. after school clubs, during break times) were covered
by the questions asked. For pre-school children, activities done at any nursery or playgroup that the
child attended were included.
The groups of activities for children:
1. Walking (not including to or from school): Walking was presented as part of the informal group of
activities. It has been analysed separately as an activity of policy interest. The walks included are of
any duration.
2. Informal activities: Activities in this group include cycling, dancing, skating, trampolining,
hopscotch, active play, skipping rope, and housework and gardening.
3. Formal sports: Activities in this group include any organised team sports such as football, rugby,
cricket, and netball, as well as running or athletics, all types of swimming, gymnastics, weight
training, aerobics and tennis. Where the ‘total physical activity’ variable has been included in the
tables, it is an aggregate of the grouped activities listed above.
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4. Walking or cycling to and from school is reported separately from other walking and cycling in
these analyses, because active travel to and from school is an important opportunity for physical
activity amongst children. The structure of the questions about active travel to school differed from
the structure for all other types of physical activity, since journeys were not related to specific
weekdays. Thus it is not possible to combine walking and cycling to school with other occasions of
walking and cycling in assessing the total amount of activity for the summary activity levels.
Objective measures of physical activity
A sub-sample of children aged 4 to 15 were asked to wear an accelerometer during the week
following the interview. The accelerometer provides a measure of frequency, intensity and duration of
physical activity, allowing classification of activity levels as sedentary, light, moderate and vigorous.
The accelerometer was worn on a specially provided belt and each child was asked to wear the
accelerometer during waking hours for seven consecutive full days; parent co-operation was also
required, particularly for younger children. The device was taken off for activities such as showering
or swimming, as the Actigraph is not waterproof. Also, some children removed their monitor during
contact sports such as karate or rugby.
For adults, current evidence suggests that moderate or vigorous activity should be accumulated in
bouts of at least 10 minutes to count towards meeting government at the time recommendations, as it
is these bouts of sustained activity that provide health benefits. However, this is not a realistic
requirement for children, since the nature of children’s physical activity typically differs from adults’,
being less likely to involve clearly defined periods of specific activities. Thus children’s activity is
much more likely to be sporadic, occurring in short bursts. For this reason, in keeping with other
studies, all of children’s moderate or vigorous activity has been taken into account in assessing
whether they have met the then government guidelines for physical activity, rather than imposing a
requirement for bouts of 10 minutes or more.
Summary activity levels for both self-reported and objective measures of physical activity in children
are:
•
Meets recommendations: At least 60 minutes of moderate activity on all seven days in the last
week.
•
Some activity: 30-59 minutes of moderate activity on all seven days in the last week.
•
Low activity: Fewer than 30 minutes of moderate activity on each day, or moderate activity of 60
minutes or more on fewer than seven days in the last week.
Active sport
The Department for Culture, Media and Sport Public Service Agreement (PSA) and the Taking Part
Survey define the following as active sports: swimming or diving; BMX, cyclo-cross, mountain biking;
cycling; bowls; tenpin bowling; health, fitness, gym or conditioning activities; keep fit, aerobics, dance
exercise; judo; karate; taekwondo; other martial arts; weight training; weightlifting; gymnastics;
snooker, pool, billiards; darts; rugby league and union; American football; football; cricket; hockey;
baseball/softball; netball; tennis; badminton; squash; basketball; table tennis; track and field athletics;
jogging, cross-country, road running; angling or fishing; canoeing; windsurfing or boardsailing; ice
skating; golf, pitch and putt, putting; skiing; horse riding; climbing/mountaineering; hill trekking or
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backpacking; karting; volleyball; orienteering; rounders; rowing; boxing; waterskiing; lacrosse; yoga;
fencing; and other types of sport for example roller-blading, street hockey, skateboarding, water polo,
surfing, scuba diving, gliding, hang/paragliding, parachuting or parascending are also included in the
valid activities which are recorded in the ‘other sports’ category. Utility cycling and all forms of walking
are excluded from the active sport target.
Diet and nutrition
Fruit and vegetable portions
Fruit and vegetable consumption is measured in portions; using guidelines specified in the ‘5 a day’
programme. The government recommends that people should eat five portions of fruit and
vegetables a day. Five portions are defined as 400g of fruit and vegetables per day, an average of
80g per portion. A variety of foodstuffs represent a portion, including vegetables (fresh, frozen,
canned), vegetables in composite dishes (such as pies or curries), salads, pulses, fruit (fresh, frozen,
canned, dried), fruit in composites (such as pies or crumbles) and fruit juice. Below is a table showing
the recommended portions sizes of the different types of fruit and vegetables in terms of everyday
household measures. These measures have been used by the Health Survey for England when
collecting data through dietary recall and for estimation of the number of portions respondents have
consumed. The Low Income Diet and Nutrition Survey also followed the government guidelines in
terms of what and how much counts as a portion, but estimated the weight of the fruit and vegetables
consumed and divided by 80 (or 157 in the case of fruit juice to convert to millilitres) to determine the
number of portions.
According the current guidelines, fruit juice, regardless of how much is drunk in excess of one small
glass (150ml), only counts as a maximum of one portion per day. This is due to its low fibre content
and its high content of non-milk extrinsic sugars, which, when consumed in too high a quantity can
lead to tooth decay and dental health problems. Pulses (such as beans, lentils and chick peas) can
also only contribute a maximum of one portion per day regardless of how much is consumed; whilst
they do contain fibre, they do not provide the same mixture of vitamins, minerals and other nutrients
that can be obtained from fruit and vegetables. Due to their high starch content, potatoes in any form
(including sweet potato varieties) and other starchy vegetables, such as plantain and green bananas,
do not count towards the ‘5 a day’ portions. Nuts and seeds do not count towards the ‘5 a day’
portions. These guidelines and quantities are based on adult requirements and while the government
recommends that children over the age of five should also consume five portions of a variety of the
foodstuffs shown below, their portion sizes may be smaller. However, survey measures of fruit and
vegetable consumption among children are based on adult portion sizes.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 98
Food item
Portion size
Vegetables (fresh, raw, tinned and frozen)
Pulses
Salad
Vegetables in composites, such as vegetable chilli
Very large fruit, such as melon
Large fruit, such as grapefruit
Medium fruit, such as apples
Small fruit, such as plums
Very small fruit, such as blueberries
Dried fruit
Frozen fruit / tinned fruit
Fruit in composites, such as stewed fruit
Fruit juice
3 tablespoons
3 tablespoons
1 cereal bowl
3 tablespoons
1 average slice
Half a fruit
1 fruit
2 fruits
2 average handfulls
1 tablespoon
3 tablespoons
3 tablespoons
1 small glass (150ml)
Estimated Average Requirements and Reference Nutrient Intakes
In 1991 the Committee on Medical Aspects of Food and Nutrition Policy (COMA) recommended that
population average intakes of different macronutrients should not exceed specified limits. For
example the population average intakes of total fat, saturated fatty acids and non-milk extrinsic
sugars (principally added sugars) should not exceed 35 per cent, 11 per cent and 11 per cent of food
energy respectively.
Energy intake is compared against the Estimated Average Requirement (EAR) for a group. Estimates
of energy requirements for different populations are termed EARs and are defined as the energy
intake estimated to meet the average requirements of the group. About half the people in the group
will usually need more energy than the EAR and half the people in the group will usually need less.
Nutrient intakes derived from surveys are compared with Reference Nutrient Intakes (RNIs). These
RNIs represent the best estimate of the amount of a nutrient that is enough, or more than enough, for
about 97 per cent of people in a group. If average intake of a group is at the level of the RNI, then the
risk of deficiency in the group is very small.
Health Survey for England (HSE)
Age Standardisation
Adult data have been age-standardised throughout the HSE 2009 to allow comparisons between
groups after adjusting for the effects of any differences in their age distributions. When different subgroups are compared in respect of a variable on which age has an important influence, any
differences in age distributions between these sub-groups are likely to affect the observed
differences in the proportions of interest. All age standardisation has been undertaken separately
within each gender, expressing male data to the overall male population and female data to the
overall female population. When comparing data for the two genders, it should be remembered that
no age standardisation has been introduced to remove the effects of the genders’ different age
distributions.
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Footnotes have been provided in this report on tables where age standardised figures have been
presented and include the following variables: equivalised household income quintile and
Government Office Region.
Further information on overweight and obesity prevalence across Strategic Health Authorities (SHAs)
is given in ‘HSE: Health and Lifestyle Indicators for Strategic Health Authorities 1994 - 2002’. This
includes an age-standardised time series of overweight and obesity prevalence levels by SHA. This
publication is available at:
http://www.dh.gov.uk/PublicationsAndStatistics/PublishedSurvey/HealthSurveyForEngland/HealthSur
veyResults/HealthSurveyResultsArticle/fs/en?CONTENT_ID=4077728&chk=5Mjlqy
Use of HSE data from different years
This report contains data and information from different years of the HSE. This is to provide the
most recent information for the general population that was available at the time of publishing.
Where possible, data has been used from the most recent HSE 2009 results, however there are
some restrictions to this.
In some cases data is not presented in the HSE reports in the format required for this report,
therefore additional analysis of the data set is undertaken. At the time of publishing, the HSE 2009
data set was not available for such additional analysis; therefore data from previous HSE survey
years was used as appropriate.
Chapter 7 discusses blood pressure, longstanding illnesses and GHQ12 (12-item General Health
Questionnaire – see below) by BMI and waist circumference. Analysis of these health conditions by
BMI and waist circumference was carried out on the 2008 dataset specifically for this publication.
GHQ12
GHQ12 is the 12-item General Health Questionnaire designed to measure self-assessed general
health, acute sickness leading to reduction in recent activity and psychosocial wellbeing.
Blood pressure
The levels of blood pressure used to define hypertension in the HSE are in accordance with the latest
guidelines on hypertension management. To compute the prevalence of hypertension, adult
informants were classified in one of four groups on the basis of their SBP (systolic blood pressure)
and DBP (diastolic blood pressure) readings and their current use of anti-hypertensive medication.
•
•
Normotensive-untreated SBP<140 mmHg and DBP<90 mmHg, not currently taking any
prescribed drugs that lower blood pressure
Hypertensive-controlled SBP<140 mmHg and DBP<90 mmHg, currently taking medication
prescribed to lower blood pressure
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•
•
Hypertensive-uncontrolled SBP≥140 mmHg and DBP≥90 mmHg, currently taking medication
prescribed to lower blood pressure
Hypertensive-untreated SBP≥140 mmHg and DBP≥90 mmHg, not currently taking any prescribed
drugs that lower blood pressure
The last three categories together are considered as ‘hypertensive’ for the purpose of this report.
The definition of hypertension used for clinical purpose talks about ‘sustained’ levels of high blood
pressure, while HSE only measures blood pressure at one point in time. This needs to be taken into
account when interpreting the results. Hypertensive controlled and hypertensive uncontrolled groups
are all those who take drugs that were prescribed to lower their blood pressure.
Weighted HSE data used in Chapter 7: Health Outcomes
Tables 7.1 and 7.2 show prevalence of blood pressure levels by BMI and waist circumference, tables
7.3 and 7.4 show longstanding illness by BMI and waist circumference and table 7.5 shows GHQ12
score by BMI. Questions on longstanding illness are asked during the interview visit, whereas blood
pressure and waist circumference are measured during the nurse visit. Different weights are used
within the HSE depending on which stage of the process the information is collected (interview or
nurse).
Totals in tables include those without a valid BMI recorded. Therefore the weighting used in analysis
needs to take account the stage of the process for which the associated variable is collected. The
blood pressure variable is collected by the nurse and therefore uses the nurse weight to calculate
weighted prevalence totals, but weighted totals for longstanding illness are based on the interview
weight since these are collected at the interview stage, however the prevalence and weighted bases
for each BMI status (normal, overweight or obese) for these conditions are based on the nurse
weight.
Further details of weighting can be found in the methodology chapter of the Health Survey for
England 2007: Healthy Lifestyles: Knowledge, attitudes and behaviour
www.ic.nhs.uk/pubs/hse07healthylifestyles
Equivalised household income quintiles
Household income was established in the HSE by means of a show-card on which banded
incomes were presented. There has been increasing interest recently in using measures
of equivalised income that adjust income to take account of the number of persons in the
household. To derive this, each household member is given a score depending, for adults,
on the number of adults apart from the household reference person, and for dependent
children, on their age. The total household income is divided by the sum of the scores to
provide the measure of equivalised household income. All individuals in each household
were allocated to the equivalised household income quintile to which their household had
been allocated.
Logistic Regression
Logistic regression is a statistical technique that examines the relationship between an outcome
variable and a number of predictor variables. In the table presented, the outcome variable is being in
the high health risk category.
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Results are displayed as odds ratios for the final model. Odds are expressed relative to a reference
category. An odds ratio of above 1 implies that people within the category are more likely to be in the
high health risk category. The 95% confidence interval is also shown. Where the interval does not
include 1, the association is unlikely to be due to random chance and we say the category is
significantly different from the reference category.
For example, the odds ratio for women in the category ‘Used to smoke cigarettes regularly’ is 1.36,
with a 95% confidence interval of 1.08-1.72. The reference category for this variable is ‘Never
smoked.’ As the odds ratio is greater than 1 and the 95% confidence interval does not contain 1, we
say that women who used to smoke cigarettes are more likely to be in the high risk health category
than women who have never smoked.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 102
Hospital Episode Statistics codes: coding for Bariatric Surgery used in
Tables 7.12 and 7.13
The term “bariatric surgery” is often used to define a group of procedures that can be
performed to facilitate weight loss although these procedures can be performed for
conditions other than weight loss. It includes stomach stapling, gastric bypasses and
sleeve gastrectomy. Using Hospital Episode Statistics (HES) data held at The NHS
Information Centre, the number of Finished Consultant Episodes (FCEs) for bariatric
surgery has been determined where the primary diagnosis was obesity (ICD-10 code
E66) and the main or secondary procedure was one of the following OPCS codes for
the relevant time periods. OPCS-4.2 codes were used between 1996/97 to 2005/06,
OPCS-4.3 codes for 2006/07, OPCS-4.4 codes for 2007/08 and 2008/09, OPCS-4.5
codes for 2009/10 and OPCS-4.6 codes for 2010/11.
The following OPCS 4.2 codes have been used for bariatric surgery from 1996/97
to 2005/06 inclusive:
G27.2 Total gastrectomy and anastomosis of oesophagus to duodenum
G27.3 Total gastrectomy and interposition of jejunum
G27.4 Total gastrectomy and anastomosis of oesophagus to transposed jejunum
G27.5 Total gastrectomy and anastomosis of oesophagus to jejunum nec
G27.8 Other specified total excision of stomach
G27.9 Unspecified total excision of stomach
G28.1 Partial gastrectomy and anastomosis of stomach to duodenum
G28.2 Partial gastrectomy and anastomosis of stomach to transposed jejunum
G28.3 Partial gastrectomy and anastomosis of stomach jejunum nec
G28.8 Other specific partial excision of stomach
G28.9 Unspecified partial excision of stomach
G30.1 Gastroplasty nec
G30.2 Partitioning of stomach nec
G30.8 Other specified plastic operations on stomach
G30.9 Unspecified plastic operations on stomach
G31.1 Bypass of stomach by anastomosis of oesophagus to duodenum
G31.2 Bypass of stomach by anastomosis of stomach to duodenum
G31.3 Revision of anastomosis of stomach to duodenum
G31.4 Conversion to anastomosis of stomach to duodenum
G31.8 Other specified connection of stomach to duodenum
G31.9 Unspecified connection of stomach to duodenum
G31.0 Conversion from pervious anastomosis of stomach to duodenum
G32.0 Conversion from previous anastomosis of stomach to transposed jejunum
G32.1 Bypass of stomach by anastomosis of stomach transposed to jejunum
G32.2 Revision of anastomosis of stomach to transposed jejunum
G32.3 Conversion to anastomosis of stomach to transposed jejunum
G32.8 Other specified connection of stomach to transposed jejunum
G32.9 Unspecified connection of stomach to transposed jejunum
103 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
G33.1 Bypass of stomach by anastomosis of stomach to jejunum nec
G33.2 Revision of anastomosis of stomach to jejunum
G33.3 Conversion of anastomosis of stomach to jejunum nec
G33.8 Other specified other connection of stomach to jejunum
G33.9 Unspecified other connection of stomach to jejunum
G33.0 Conversion from previous anastomosis of stomach to jejunum nec
G38.8 Other specified other open operations on stomach
G48.1 Insertion of gastric bubble
G48.2 Attention of gastric bubble
The following OPCS 4.3/OPCS 4.4 codes in addition to the above have been used
for bariatric surgery from 2006/07 to 2008/09 inclusive:
G28.4 Sleeve gastrectomy and duodenal switch
G28.5 Sleeve gastrectomy nec
G30.3 Partitioning of stomach using band
G30.4 Partitioning of stomach using staples
G31.5 Closure of connection of stomach and duodenum
G31.6 Attention of connection of stomach and duodenum
G32.4 Closure of connection of stomach to transposed jejunum
G32.5 Attention to connection of stomach to transposed jejunum
G33.5 Closure of connection of stomach to jejunum nec
G33.6 Attention to connection of stomach to jejunum
G38.7 Removal of gastric band
G71.6 Duodenal switch
The following OPCS-4.5 procedure codes have been used for bariatric surgery
for 2009/10:
G27.1 Total gastrectomy and excision of surrounding tissue
G27.2 Total gastrectomy and anastomosis of oesophagus to duodenum
G27.3 Total gastrectomy and interposition of jejunum
G27.4 Total gastrectomy and anastomosis of oesophagus to transposed jejunum
G27.5 Total gastrectomy and anastomosis of oesophagus to jejunum nec
G27.8 Other specified total excision of stomach
G27.9 Unspecified total excision of stomach
G28.1 Partial gastrectomy and anastomosis of stomach to duodenum
G28.2 Partial gastrectomy and anastomosis of stomach to transposed jejunum
G28.3 Partial gastrectomy and anastomosis of stomach to jejunum nec
G28.8 Other specified partial excision of stomach
G28.9 Unspecified partial excision of stomach
G31.1 Bypass of stomach by anastomosis of oesophagus to duodenum
G31.2 Bypass of stomach by anastomosis of stomach to duodenum
G31.3 Revision of anastomosis of stomach to duodenum
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 104
G31.4 Conversion to anastomosis of stomach to duodenum
G31.8 Other specified connection of stomach to duodenum
G31.9 Unspecified connection of stomach to duodenum
G31.0 Conversion from previous anastomosis of stomach to duodenum
G32.0 Conversion from previous anastomosis of stomach to transposed jejunum
G32.1 Bypass of stomach by anastomosis of stomach to transposed jejunum
G32.2 Revision of anastomosis of stomach to transposed jejunum
G32.3 Conversion to anastomosis of stomach to transposed jejunum
G32.8 Other specified connection of stomach to transposed jejunum
G32.9 Unspecified connection of stomach to transposed jejunum
G33.1 Bypass of stomach by anastomosis of stomach to jejunum nec
G33.2 Revision of anastomosis of stomach to jejunum
G33.3 Conversion of anastomosis of stomach to jejunum nec
G33.8 Other specified other connection of stomach to jejunum
G33.9 Unspecified other connection of stomach to jejunum
G33.0 Conversion from previous anastomosis of stomach to jejunum nec
G48.1 Insertion of gastric bubble
G48.2 Attention to gastric bubble
G28.4 Sleeve gastrectomy and duodenal switch
G28.5 Sleeve gastrectomy NEC
G30.3 Partitioning of stomach using band
G30.4 Partitioning of stomach using staples
G30.5 Maintenance of gastric band
G31.5 Closure of connection of stomach to duodenum
G31.6 Attention to connection of stomach to duodenum
G32.4 Closure of connection of stomach to transposed jejunum
G32.5 Attention to connection of stomach to transposed jejunum
G33.5 Closure of connection of stomach to jejunum NEC
G33.6 Attention to connection of stomach to jejunum
G38.7 Removal of gastric band
G71.6 Duodenal switch
The following OPCS-4.6 procedure codes, in addition to the above codes used in
2009/10, have been used for bariatric surgery for 2010/11:
G48.5 Insertion of gastric balloon
G48.6 Attention to gastric balloon
G71.7 Reversal of duodenal switch
105 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Appendix C: Government policy, targets and
outcome indicators
Public Health Outcomes Framework
Recently launched in January 2012, the Public Health Outcomes Framework is comprised of a
number of indicators against which Public Health delivery partners will be encouraged to demonstrate
improvement. The introduction of the framework will act as a stimulus to encourage public health
delivery partners to make significant improvements in services and share best practice more widely.
The intention is that the introduction of benchmarking (through the indicator measures) will have a
strong impact on improving public health outcomes – this is consistent with recent evidence that the
introduction of indicator measures can have a strong influence on achieving successful Health
Outcomes - and will have a direct effect on protecting and improving the nation’s health. For further
information, see link:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_13235
8
Healthy Lives, Healthy People: A call to action on obesity in England
This document published in October 2011 sets out how the new approach to public health will
enable effective action on obesity and encourages a wide range of partners to play their part. For a
full copy of the report, follow the link below:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_13040
1
The eatwell plate
Updated from the Balance of Good Health in August 2011, the eatwell plate is a policy tool that
defines the Government’s recommendations on healthy diets. It makes healthy eating easier to
understand by giving a visual representation of the types and proportions of foods needed for a
healthy and well balanced diet. For further information, see link:
www.dh.gov.uk/en/Publichealth/Nutrition/DH_126493
Start active, stay active: a report on physical activity from the four home countries'
Chief Medical Officers
Launched in July 2011, this UK-wide report presents guidelines on the volume, duration, frequency
and type of physical activity required across the lifecourse to achieve general health benefits. It is
aimed at the NHS, local authorities and a range of other organisations designing services to promote
physical activity. The document is intended for professionals, practitioners and policymakers
concerned with formulating and implementing policies and programmes that utilise the promotion of
physical activity, sport, exercise and active travel to achieve health gains. For further information, see
link:
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 106
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_1
28209
Public Health Responsibility Deal
What we eat, how much we drink and how active we are is heavily shaped by our environment.
Creating the right environment can encourage and empower people to take responsibility for their
health and make healthy choices.
Launched on 15 March 2011, the Public Health Responsibility Deal has been established to tap into
the potential for businesses and other organisations to improve public health and tackle health
inequalities through their influence over food, alcohol, physical activity and health in the workplace.
For further information, see link:
www.dh.gov.uk/en/Publichealth/Publichealthresponsibilitydeal/index.htm
Plans for the Legacy from the 2012 Olympic and Paralympic Games
The Coalition Government published its plans in December 2010 to producing a safe and secure
Games that leaves a lasting legacy. The task is not only to ensure that the Games are a success as
iconic sporting occasions but also that the most is made from the Games for the nation. The
Government will focus on four areas in doing this:
•
Harnessing the United Kingdom’s passion for sport to increase grass roots participation,
particularly by young people – and to encourage the whole population to be more physically
active
•
Exploiting to the full the opportunities for economic growth offered by hosting the Games
•
Promoting community engagement and achieving participation across all groups in society
through the Games; and
•
Ensuring that the OIympic Park can be developed after the Games as one of the principal drivers
of regeneration in East London.
For further information, see link: http://www.culture.gov.uk/publications/7674.aspx
Healthy Lives, Healthy People: Our Strategy for Public Health in England
This latest White Paper, published in November 2010, sets out the Government’s long-term vision
for the future of public health in England. The aim is to strengthen both national and local leadership.
For a full copy of the report follow the link:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_12194
1
Public Service Agreements
The new coalition government ended the system of Public Service Agreements (PSAs) set at
national level in 2010. For the meantime these are to be replaced by Departmental business plans,
107 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
which each Government department has recently published setting out the details of its reform plans,
including its:
•
vision and priorities to 2014-15;
•
structural reform plan, including actions and deadlines for implementing reforms over the next
two years; and
•
contribution to transparency, including the key indicators against which it will publish data to
show the cost and impact of public services and departmental activities. However some PSA
targets have been included in this report as they may have been in place when the data were
collected.
A link to the Department of Health’s Business Plan (2011-2015) can be found following this link:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_12139
3
National Indicator Set
The Audit Commission was commissioned by the previous government to publish the National
Indicator Set (NIS) as part of the assessment of local areas' ‘Comprehensive Area Assessment’
(CAA). In May 2010, the new government announced their intention to abolish CAA. The Audit
Commission stopped work on updates to the assessments and decided not to update the National
Indicator data on the CAA website.
Change4Life
In January 2009, the previous government launched an ambitious new campaign Change 4 Life – a
society wide movement that aims to prevent people from becoming overweight by encouraging them
to eat better and move more. The coalition government sets out in the White Paper, Healthy Lives,
Healthy People: Our Strategy for Public Health in England, its plans to broaden the Change4Life
programme to take a more holistic approach to childhood issues, for instance covering strategies to
help parents talk to their children about other health issues and behaviour, such as alcohol.
For further information on this campaign, follow the link below:
www.nhs.uk/change4life/Pages/change-for-life.aspx
The Change4Life campaign has recently been expanded to focus on adults to encourage them to
increase their physical activity levels.
For further information, follow the link below:
http://www.nhs.uk/Change4Life/Pages/daily-activity-tips.aspx
NICE guidance
The guidance on the prevention, identification, assessment, treatment and weight management of
overweight and obesity in adults and children was intended to provide recommendations on the
clinical management of overweight and obesity in the NHS. It also provides guidance on primary
prevention approaches aimed at supporting adults and children to maintain a healthy weight.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 108
The guidance was published in December 2006 and can be accessed on the NICE website:
http://www.nice.org.uk/guidance/CG43
5-A-Day programme
The 5-A-DAY programme was launched in March 2003 as part of the health promotion activity by the
Department of Health to encourage people to eat more fruit and vegetables. It aims to increase fruit
and vegetable consumption by:
•
•
•
raising awareness of the health benefits through targeted communications
and improving access to fruit and vegetables
working with national, regional and local organisations.
The Food Standards Agency (FSA) Consumer Attitudes Survey 2007 showed that 79% of adults
were aware that they should eat at least five portions of fruit and vegetables a day, up from 43% in
2000.
There is continued support for the Programme from the coalition government.
For further information, please see link:
www.nhs.uk/5aday
109 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Appendix D: Further information
This new report (published 23rd February 2012) draws together statistics on obesity, physical activity
and diet. This report forms part of a suite of statistical reports covering, in addition, drug misuse,
alcohol and smoking.
Constructive comments on this report would be welcomed. Any questions concerning any data in
this publication, or requests for further information, should be addressed to:
The Contact Centre
The Information Centre
1 Trevelyan Square
Boar Lane
Leeds
West Yorkshire
LS1 6AE
Telephone: 0845 300 6016
Email: [email protected]
Press enquiries should be made to:
Media Relations Manager:
Telephone: 0845 300 6016
Email: [email protected]
This report is available on the internet at:
www.ic.nhs.uk/pubs/opad12
Previous reports on Statistics on obesity, physical Activity and diet: England can be found on The
NHS Information Centre website:
http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/obesity
Information on data sources used within this report are described in Appendix A and government
plans and targets discussed in Appendix C. However further information regarding the topics
discussed within this report maybe found from the following sources:
5-a-day
The 5-a-day website provides lots of useful information and resources for health professionals as well
as the general public about healthy eating and fruit and vegetable consumption
http://www.5aday.nhs.uk/
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 110
Annual Report of the Chief Medical Officer
Over the last 150 years, annual reports have been published by the Chief Medical Officer, almost
every year. These reports provide an important record of the nation’s health and the major
challenges faced by government in tackling the main problems. In the last twenty years or so, the
annual report has also provided detailed accounts of a wide range of initiatives taken by the
government on public health and in the NHS.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/AnnualReports/DH_096206
Association for the Study of Obesity
The Association for the Study of Obesity (ASO) was founded in 1967 and is the UK's foremost
organisation dedicated to the understanding and treatment of obesity. The ASO has three key
objectives:
•
•
•
•
To promote professional awareness of obesity and its impact on health.
To educate and disseminate recent research on the causes, consequences, treatment, and
prevention of obesity
To prioritise obesity and provide opinion leadership in the UK.
http://www.aso.org.uk
Eurostat
Data presented on BMI by European Union (EU) countries, collected by Eurostat uses Health
Interview Surveys (HIS). The HIS data are collected in different years depending on the country,
ranging from 1996 to 2003. There is no fixed periodicity in these kinds of health surveys. Very few
countries have a yearly survey on these topics. Data are disseminated simultaneously to all
interested parties through a database update and on Eurostat's website.
There are other sources available which present international figures on BMI. A source of such data
is the World Health Organisation (WHO). The source of BMI from WHO varies from country to
country. The prevalence of obesity among EU countries is broadly similar between Eurostat and
WHO.
Eurostat. Available at:
http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home
Food Standards Agency
The Food Standards Agency (FSA) is an independent government department set up by an Act of
Parliament in 2000 to protect the public's health and consumer interests in relation to food. The FSA
provides advice and information to the public and government on food safety from farm to fork,
nutrition and diet. It also protects consumers through effective food enforcement and monitoring.
Although the FSA is a government agency, it works at 'arm's length' from government because it
does not report to a specific minister and is free to publish any advice it issues.
http://www.food.gov.uk/
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General Lifestyle Survey (formerly General Household Survey)
The General Lifestyle Survey (GLF) is a multi purpose continuous survey carried out by the Office of
National Statistics (ONS) which collects information on a range of topics from people living in
households in Great Britain. The survey started in 1971.
http://www.statistics.gov.uk/statbase/product.asp?vlnk=5756
International Obesity TaskForce
The International Obesity TaskForce (IOTF) is a global network of expertise, a research-led think
tank and advocacy arm of the IOTF. The IOTF is working to alert the world to the growing health
crisis threatened by soaring levels of obesity. It works with the World Health Organisation, other
NGOs and stakeholders to address this challenge.
www.iotf.org
National Institute for Health and Clinical Excellence (NICE)
The NICE website includes some information and clinical guidelines on the prevention, identification,
assessment and management of overweight and obesity in adults and children.
http://www.nice.org.uk/CG43
National Obesity Forum
The National Obesity Forum (NOF) was established by medical practitioners in May 2000 to raise
awareness of the growing health impact that being overweight or obese was having on patients and
the NHS
http://www.nationalobesityforum.org.uk/
National Child Measurement Programme
The National Child Measurement Programme (NCMP) weighs and measures children in Reception
(aged 4–5 years) and Year 6 (aged 10–11 years). The findings are used to inform local planning and
delivery of services for children, and gather population-level surveillance data to allow analysis of
trends in excess weight. The latest NCMP data, for the school year 2010/11, has been collected by
The NHS Information Centre (IC) and a national report is available from:
www.ic.nhs.uk/ncmp
Primary Care Management of Adult Obesity – Dr Foster
The aim of the report Primary Care Management of Adult Obesity, published by Dr Foster, is to
examine the degree to which Primary Care Organisations (PCOs) across the UK are currently
tackling the problem of obesity.
http://www.drfosterintelligence.co.uk/library/reports/obesityManagement.pdf
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 112
School Fruit and Vegetable Scheme
Under the scheme, all four to six year old children in Local Education Authority maintained infant,
primary and special schools are now entitled to a free piece of fruit or vegetable each school day. It
was introduced after the NHS Plan 2000 included a commitment to implement a national school fruit
scheme by 2004.
www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/FiveADay/FiveADaygeneralinforma
tion/DH_4002149
Scientific Advisory Committee on Nutrition
The Scientific Advisory Committee on Nutrition (SACN) is an advisory committee of independent
experts that provides advice to the Food Standards Agency and Department of Health as well as
other government agencies and departments. Its remit includes matters concerning nutrient content
of individual foods, advice on diet and the nutritional status of people.
www.sacn.gov.uk/
Scottish Health Survey
The Scottish Health Survey provides information on the health and health-related behaviours of
people living in private households in Scotland. Among the Surveys’ aims are to estimate the
prevalence of a range of health conditions and to monitor progress towards Scottish health and
dietary targets. The 2010 survey is the sixth in a series which began in 1995 with a survey of adults
aged 16 to 64. The 1998 survey also included children aged 2 to15 and adults aged 65 to 74 for the
first time. From 2003, the survey did not have any age limits and included children from 0 upwards
and adults aged 16 and over. All six surveys were commissioned by what is now the Scottish
Executive Health Department.
The Scottish Health Survey 2010. Available at:
http://www.scotland.gov.uk/Publications/2011/09/27084018/91
Securing Good Health for the Whole Population
Derek Wanless’ first report ‘Securing our Future Health: Taking a Long-Term View’ was published in
April 2002. This identified three scenarios for meeting the long-term financial and resource needs of
the NHS for the next two decades, to 2022. In its response to the report, the government announced
that it would address the ‘fully engaged’ scenario identified by Mr Wanless. Under this scenario the
level of public engagement in relation to health is high, life expectancy goes beyond current
forecasts, health status improves dramatically, use of resources is more efficient and the health
service is responsive with high rates of technology uptake. The scenario envisaged delivery of better
health outcomes at less cost than the others considered.
In April 2003, the then Prime Minister, the Chancellor and the Secretary of State for Health asked
Derek Wanless, ex-Group Chief Executive of NatWest, to provide an update of the challenges in
implementing the fully engaged scenario set out in his report on long-term health trends. Derek
Wanless' final report "Securing Good Health for the Whole Population" was published on 25th
February 2004.
www.hm-treasury.gov.uk/consultations_and_legislation/wanless/consult_wanless04_final.cfm
113 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
South East Public Health Observatory
The South East Public Health Observatory (SEPHO) is one of nine regional observatories throughout
England and Wales and is a member of the Association of Public Health Observatories (APHO).
SEPHO’s aim is to improve health and reduce inequalities in the South East region by providing
information and support to local organisations, partners and stakeholders.
As part of the PHO Choosing Health series, the report Choosing Health in the South East: Obesity
defines obesity and overweight, its causes and impacts on health, and looks at this issue as it varies
with geography, age, gender, ethnicity, etc. It also discusses obesity and overweight in children and
interventions.
http://www.sepho.org.uk/Download/Public/9783/1/SEPHO%20obesity%20report%20Nov%2005.pdf
Tackling child obesity
This report is based on a joint study conducted by the Audit Commission, the Healthcare
Commission and the National Audit Office, one of a series that looks at the “delivery chains” between
important national policy intentions (set out in government departments’ Public Service Agreement
targets agreed with HM Treasury) and local delivery.
www.nao.org.uk/publications/nao_reports/05-06/0506801.pdf
Time Use Survey
The UK Time Use Survey is conducted on behalf of a funding consortium consisting of: the Economic
and Social Research Council; the Department of Culture, Media and Sport; the Department for
Education and Skills; the Department of Health; the Department of Transport, Local Government and
the Regions; and the Office for National Statistics.
The main aim of the survey was to measure the amount of time spent by the UK population on
various activities. The UK 2000 Time Use Survey was the first time that a major survey of this type
has been conducted in the UK and as such provides an opportunity to inform a cross-section of
policy areas as well as having interest for academia, social research centres and the advertising and
retail sector.
In 2000, the first Time Use Survey was carried out using a combination of questionnaires and diaries.
In 2005, a pre-coded time use diary was used to collect the results from adults aged 16 and over as
part of the National Statistics Omnibus Survey. The Omnibus diary results are compared with the
data collected in the UK 2000 Time Use Survey.
http://www.statistics.gov.uk/cci/article.asp?ID=1600
Welsh Health Survey 2010
The Welsh Health Survey is a source of information about the health of people living in Wales, the
way they use health services, and the things that can affect their health and is produced by the
Welsh Assembly Government. This survey replaced two previous surveys: the former Welsh Health
Survey (undertaken in 1995 and 1998) and the former Health in Wales Survey (undertaken every two
to three years between 1985 and 1996). Results from this survey are not comparable with those from
the previous surveys because of differences in the questionnaires and the way the survey is
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 114
designed and conducted. One addition to the survey is the collection of some limited information on
children’s health. More detailed information for children is collected from 2007 onwards.
The Welsh Health Survey 2010. Available at:
http://wales.gov.uk/docs/statistics/2011/110913healthsurvey10en.pdf
World Health Organisation
The World Health Organisation (WHO) have a created a global database on BMI. This database
provides both national and sub-national adult underweight, overweight and obesity prevalence rates
by country, year of survey and gender. The information is presented interactively as maps, tables,
graphs and downloadable documents.
www.who.int/bmi/index.jsp
115 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
Appendix E: United Kingdom Statistics Authority
Assessment of the Statistics on Obesity, Physical
Activity and Diet: England publication
During 2010, the Statistics on Obesity, Physical Activity and Diet: England report, along with the
three other publications (smoking, alcohol and drug misuse) that comprise the Lifestyles
Compendium Publications published by the NHS Information Centre underwent assessment by the
United Kingdom Statistics Authority. Following assessment, the publications were designated
continued National Statistics status (see below):
The United Kingdom Statistics Authority has designated these statistics as National Statistics, subject
to meeting the requirements below, in accordance with the Statistics and Registration Service Act
2007 and signifying compliance with the Code of Practice for Official Statistics.
Designation can be broadly interpreted to mean that the statistics:
• meet identified user needs;
• are well explained and readily accessible;
• are produced according to sound methods; and
• are managed impartially and objectively in the public interest.
Once statistics have been designated as National Statistics it is a statutory requirement that the Code
of Practice shall continue to be observed.
The designation of National Statistics status was subject to a number of requirements and the UKSA
report also contained a number of suggestions for improvements. These, together with detail on how
these addressed by the NHS IC are below:
Requirement 1 Take steps to develop a greater understanding of the use made of the statistics;
publish the relevant information and assumptions, and use them to better support the use of the
statistics (para 3.2)
A public consultation was launched by the NHS Information Centre on 1 April 2011 and ran for 12
weeks until 24 June 2011. Responses have been collated and assessed.
www.ic.nhs.uk/work-with-us/consultations/lifestyles-statistics-compendia-publications-consultation
The consultation aimed to engage with users of the reports to develop further understanding of how
the reports are used, by whom, and for what purposes in order to also ensure the reports maintain
their relevance and usefulness.
We place a feedback form on each of our statistical release web pages inviting comments and
suggestions for improvements to our official statistics. A summary of queries and comments received
by the statistical production team are published alongside this report.
Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved. 116
Requirement 2 Include an explanation of the distinction between National Statistics, other official
statistics and statistics that are not official, and comment on the extent to which they are reliable
(para 3.11).
Addressed in the ‘Introduction’ and Appendix A. A ‘Data Quality’ statement accompanies this report.
Requirement 3 Determine the most appropriate format for the compendia, in
consultation with users (para 3.22).
This was determined by the public consultation launched by the NHS Information Centre and was
implemented from August onwards.
Requirement 4 Include the name of the responsible statistician in the Statistics
on Drug Misuse: England compendium (para 3.28).
Actioned in ‘Statistics on Drug Misuse: England, 2010’ published on 27 January 2011, and has also
been included in all subsequent publications since.
Requirement 5 Complete their Statement of Administrative Sources so that it
covers all the sources currently used (para 3.29).
This has been completed and is available at:
http://www.ic.nhs.uk/statistics-and-data-collections/publications-calendar/administrative-sources
Suggestion 1 Publish the information about users gained from the contact
centre and via the website (para 3.3).
Aggregated information for this publication accompanies this report.
Suggestion 2 Seek user input into the data accuracy measures that would best meet user
needs (para 3.10).
This was captured via the compendia consultation:
www.ic.nhs.uk/work-with-us/consultations/lifestyles-statistics-compendia-publications-consultation
Suggestion 3 Review the graphs and tables in the compendia in order to make presentation
consistent (para 3.22).
The results are reflected in this publication wherever possible.
A copy of the full UKSA assessment report is available on the following link:
http://www.statisticsauthority.gov.uk/assessment/assessment/assessment-reports/index.html
117 Copyright © 2012, The Health and Social Care Information Centre. All Rights Reserved.
ISBN: 978-1-84636-664-2
This publication may be requested in large print or other formats.
Responsible Statistician
Paul Eastwood, Lifestyle Statistics Section Head
For further information:
www.ic.nhs.uk
0845 300 6016
[email protected]
Copyright © 2012 The Health and Social Care Information Centre, Lifestyles Statistics. All rights
reserved.
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and may only be reproduced where there is explicit reference to the ownership of The Health and
Social Care Information Centre.
This work may be re-used by NHS and government organisations without permission.
This work is subject to the Re-Use of Public Sector Information Regulations and permission for
commercial use must be obtained from the copyright holder.
Copyright © 2011, The Health and Social Care Information Centre. All Rights Reserved.